HomeMy WebLinkAbout479201 HEATH CONSTRUCTION - INSURANCE CERTIFICATE (6)Y521'01I2%IN1'
O
N A Q0 DATE (MMIDDIYYYY)
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:
IRA, Inc. - Colorado Division PHONE FAX
WC. Na.E1B) --__— -__ ___ No): _
E-MAIL DenhecountTechaeimaCorp.CCm
1705 17th Street _ADDRESS:
Suite 100 INSURER(S)AFFORDING COVERAGE _ NAICI
Denver, CO 80202 INSURERA: HARTFORD FIRE IN CO 19682
INSURED INSURERS: TRUMBULL INS CO (HartfOrd Inanran" CO) 27120
Heath Construction, LLC dba SaundersHeath INSURER C BNDURMCE AMER INS CO 10641
141 Racquette Drive INSURER0: PINNACOL ASSUR _ 41190
P.O. Box Drawer H INSURERE:
Fort Collins, CO 80522 INSURERF:
rnvcoAcee rCDTICI1 ATF lilluRFD- 54195322 RFVISION NUMRFR-
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.
-INSRIT TYPE OF INSURANCE At-) SUBR POLICY NUMBER MPMOILDICY EFF YWDO1YYYY LIMITS
LTR
A
X
COMMERCIAL GENERAL LIABILITY
34UFAZT7859
04/30/18
04/30/19
EACHOCCURRENCE
$ 1,000,000
CLAIMS -MADE f � OCCUR
DA
PREMISESEa occurrence)
f 300,000
X
MED EXP (Any one person)
f 10,000
$5, 000 PD Deductible
PERSONAL 4 ADV INJURY
$ 1,000,000
GENT AGGREGATE LIMIT APPI. IES PER:
GENERAL AGGREGATE
i 2,000,000
PRODUCTS - COMP/OP AGG
= 2,000,000
POLICY JECOT- [_ ] LOC
$
OTHER:
D
AUTOMOBILE LIABILITY
34UEAZT7860
04/30/18
04/30/19
COMBINED SINGLE LIMIT
a accident
$ 1,000,000
_ _ _
BODILY INJURY (Per person)
$
X ANY AUTO
BODILY INJURY (Per accident)
i
OWNED SCHEDULED
_ AUTOS ONLY AUTOS
X HIRED X NON -OWNED
AUTOS ONLY AUTOS ONLY
PROPERTY DAMAGE
Per accident)
$
$
C
X
UMBRELLA LIAO
X
OCCUR
XSC30000649200
04/30/18
04/30/19
EACH OCCURRENCE
$ 10,000,000
AGGREGATE
$ 10, 000, 000
CLAIMS-MADE
llrmm�
D
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANYPROPRIETOR/PARTNERIEXECUTIVE
OFFICERlMEMBEREXCLUDED?
(Mandatory In NH)
NIA
3096125 - Colorado
10/01/18
10/01/19
PER TH-
X STATUTE ER
E.L. EACH ACCIDENT
f 1,000,000
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
E.L. DISEASE - POLICY LIMIT
f 1,000,000
It yes, describe under
DESCRIPTION OF OPERATIONS below
I
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
City of Fort Collins, Admin Services Purchasing Division are included as Additional Insureds on the General Liability
Policy if required by written contract or agreement and with respect to work performed by Insured subject to the policy
terms and conditions.
CERTIFICATE HOLDER I.ANI,CLL %I IUIV
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Fort Collins THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Admin Services Purchasing Division ACCORDANCE WITH THE POLICY PROVISIONS.
PO Box 580 AUTHORIZED REPRESENTATIVE
Fort Collins, CO 80522-0580 /
USA Z&
U 19BU-2015 ACURD GUKFUKA I IUN. All rlgnts reservea.
ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
2018spm60
54195322
P17
M
a
7
W