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HomeMy WebLinkAbout501461 CONSTRUCTION CONCEPTS INC - INSURANCE CERTIFICATE (2)AC" " CERTIFICATE OF LIABILITY INSURANCE D9�Ze�2o e ) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements . PRODUCER CONTACT NAME: KdrOle Peters Ewing -Leavitt Insurance Agency, Inc. PHONE (970) 679-7355 A No: (866)4237-2178 4090 Clydesdale Parkway ADDRESS: karole-peters@leavitt.com Suite 101 INSURERS AFFORDING COVERAGE NAIC 0 Loveland CO 80538 INSURER A Addison Insurance Company 110324 INSURED B:Pinnacol As Construction Concepts Inc -INSURER CAtlantic Specialty Insurance 27154 14125 Mead Street INSURERD: INSURER E : Longmont CO 80504 INSURERF: COVERAGES rFRTIFIrATF NI IMRFR•18-19 UPDATE RFVIRIr1N NI IMRFR• THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR POLICY NUMBER LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Fx]OCCUR Blkt Additional Insured X 60509044 10/l/2018 10/1/2019 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence) $ 500,000 X MED EXP (Any one person $ 10,000 X Blkt Waiver of Subro PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PRI- ECT I: LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS X NON -OWNED AUTOS Blkt Al X Blkt WOS X 60509044 10/1/2018 10/1/2019 COMBINED SINGLE LIMIT Ea accident $ 1,000,000 X BODILY INJURY (Per person) $ BODILY INJURY Per accident) $ X PROPERTY DAMAGE Per accident $ X $ A X UMBRELLA LIAR EXCESS LIAR X OCCUR CLAIMS -MADE 60509044 10/1/2018 10/l/2019 EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 DED I X I RETENTION 0 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA 4031745 Blanket Waiver of Subrogation included 7/1/2018 7/1/2019 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 C A Builders Risk- Reporting Leased/Rented Equipment 790-01-03-05-0007 60509044 10/l/2018 10/1/2018 10/1/2019 10/1/2019 Any one structure ($1,000 ded) $2,500,000 Urnit with $1,000 ded $150,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Oak Street Restrooms. The City of Fort Collins is named as additional insured on the general liability and auto liability as regards work performed by the insured per written agreement. Ia SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Fort Collins THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 214 North Mason Street ACCORDANCE WITH THE POLICY PROVISIONS. 2nd Floor Fort Collins, CO 80524 AUTHORIZED REPRESENTATIVE Karole Peters/KAPETE aox<-!� i �2 "tom Ili ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INCn9S nnl n- �