HomeMy WebLinkAbout479201 HEATH CONSTRUCTION - INSURANCE CERTIFICATE (4)i„oen_x,e
_ 7 DATE(MM/DD/YYYY)
AC 40RV CERTIFICATE OF LIABILITY INSURANCE 10/01/2018
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 CONTACT
NAME:
IKA, Inc. - Colorado Division PHONE
E�WAL
1705 17th Street ADDRESS: DenACCOUIItTeChBeimaCOr'D.COm
Suite 100 INSURE S AFFORDING COVERAGE NAICf
Denver, CO 80202 _INSURER A:EMTFORD FIRS IN CO 19682
INSURED INSURERS: TRUMBULL INS CO (Hartford Insurance CO) 27120
Heath Construction, LLC dba SaundersHeath MMUPAWS AMER INS CO 20641
INSURER C : _ _
141 RacQuette Drive INSURERD: PINNACOL ASSIHL 41190
P.O. Box Drawer H INSURER E:
Fort Collins, CO 80522 INSURER F:
rnveowr_ee PCOTlrl/`ATC klnlaLicv• S419SISO RFVIRInM NIIURFR-
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 ADDL SUBR POLICY EFF POLICY EXP LIMITS
LTR TYPE OF INSURANCE POLICY NUMBER MWD ,AWDDNYYY
A
X
COMMERCIAL GENERALLUIBRJTY
34UEAZT7859
04/30/18
04/30/19
EACH OCCURRENCE
$ 1,000,000
CLAIMS -MADE ril OCCUR
DAMAGE TO RENTED
PREMISES Ea occurrence
$ 300,000
X
MED EXP (Any one person)
$ 10,000
$5, 000 PD Deductible
PERSONAL BADVINJURY
$ 1,000,000
AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 2,000,000
GENT
PRODUCTS-COMPIOPAGG
$ 2,000,000
POLICY [X PRIJECT � LOC
_
OTHER.
B
AUTOMOBILE LIABILITY
34UEAZT7860
04/30/18
04/30/19
COEaMBINED SINGLE LIMIT
accident
: 11000,000
_
BODILY INJURY (Per person)
$
_
X ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
X HIRED X NON -OWNED
AUTOS ONLY AUTOS ONLY
BODILY INJURY (Per accident){
PROPERTY DAMAGE
Per accident
_
$
C
X
UMBRELLALUB
X
OCCUR
XSC30000649200
04/30/18
04/30/19
EACH OCCURRENCE
$ 10,000,000
AGGREGATE
$ 10, 000, 000
EXCESS LIAR
CLAIMS -MADE
DED RETENTION
-PER
$
D
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANYPROPRIETORIPARTNER/EXECUTIVE
OFFICER/MEMBEREXCLUDED9IN I
(Mandatory In NH)
NIA
3096125 - Colorado
10/01/18
10/01/19
O1*W
X 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
If yes, describe under
DESCRIPTION OF OPERATIONS bel(m
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
r CnIrIGV`ATC ur%i ncn rAMrFI 1 ATInM
RE: Contractor License.
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.
Attn: Delynn Coldiron
AUTHORIZED REPRESENTATIVE
PO Box 580
Fort Collins, CO 80522-OS80
/
USA
l /
U 1988-2015 AGURD GUKPOKA I ION. All rlgnt5 reservea.
ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
2018spm60
54195350