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Home My WebLink About592927 HASELDEN CONSTRUCTION LLC - INSURANCE CERTIFICATEP5261M1281N12 AC40RU� CERTIFICATE OF LIABILITY INSURANCE 10 / 17 /2018 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 have ADDITIONAL INSURED provisions or 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 endorsement(s). PRODUCER 1-303-534-4567 IMA, Inc. - Colorado Division CONTACT NAME: _— PHONE FAX No. Ext1: INC, No): _ E-MAIL ADDRESS. denaccounttechs@imacorp.cam 1705 17th Street INSURERS AFFORDING COVERAGE NAICN Suite 100 .. INSURERA:VALL13Y FORGE INS CO (CNA) 20508 Denver, CO 80202 INSURED INSURERS: CONTINENTAL INS CO (CNA) 35289 Haselden Construction, LLC INSURER C PINNACOL ASSUR 41190 INSURERO: INDIAN HARBOR INS CO(XL Ins.) 36940 6950 South Potomac Street INSURERS: HANOVER INS CO 22292 INSURER F: Centennial, CO 80112 COVERAGES CERTIFICATE NUMBER: 54369497 REVISION NUMBER: 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. ILTR TYPE OF INSURANCE ADDL INSO SUER POLICY NUMBER MMIDDPOLICYIYYI'Y MMIDDIYY P LIMITS A X COMMERCIAL GENERAL LIABILITY 4028808411 07/01/18 07/01/19 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE 111 OCCUR DAMAGE TO RENTED- PREMISES Ea occurrence)$ 1,000,000 X MED EXP (Any one person) $ 15,000 PD Ded: $10, 000 PERSONAL & ADV INJURY S 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY [_X JEC7 CX� LOC s - OTHER: A AUTOMOBILE LIABILITY C4028808425 07/01/18 07/01/19 CEOaMBiNpoci�EntSINGLE LIMIT $ 1,000,000 BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY (Per accident) $ OWNED SCHEDULED AUTOS ONLY AUTOS IX HIRED NON -OWNED X AUTOS ONLY X AUTOS ONLY PROPERTY DAMAGE Per accident $ $ H X UMBRELLA LIAS X OCCUR 6042783626 07/01/18 07/01/19 EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10, 000, 000 EXCESS LIAR CLAIMS -MADE DED I X I RETENTIONS 10, 000 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETORIPARTNERIEXECUTIVE a OFFICER/MEMBEREXCLUDED? (Mandatory in NH) N / A 4082635 - CO ONLY 07/01/18 07/01/19 X STATUTE ERH E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - FA EMPLOYEE $ 1,000,000 E.L. DISEASE -POLICY LIMIT $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If mom space is required) City of Fort Collins, its officers, agents and employees are included as Additional Insureds on the General, Automobile and Umbrella Liability Policies and Loss Payee on the Builders Risk Coverage if required by written contract or agreement and with respect to work performed by Insured subject to the policy terms and conditions. GtKIIFII.A1t IIVLUGK RE: Grandview Cemetery Mausoleum Work Order Number PR-600107 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Fort Collins THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 580 AUTHORIZED REPRESENTATIVE ,�;n 1. Fort Collins, CO 80522 / / i i USA ACORD 25 (2016/03) michael.sheinberg 54369497 V IVOC-LUDO A%,VRU I,VRI'VI[Ar rvm. Aa rrynia reeacrvou. The ACORD name and logo are registered marks of ACORD W. O N