HomeMy WebLinkAbout109363 ALLIANCE CONSTRUCTION SOLUTIONS LLC - INSURANCE CERTIFICATE (3)A � . R"
� CERTIFICATE OF LIABILITY INSURANCE
DATE /21 /20I18
12/21/2016
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
CONTACT Melanie Lathouwers, CIC
NAME:
Flood and Peterson
Arc PHONE Ext : (720) 977-6022 we No): (720) 977-7113
E-MAIL MLathouwers@floodpeterson.com
ADDRESS:
PO Box 578
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURERA: Liberty Mutual Insurance Group
Greeley CO 80632
INSURED
INSURER B : Liberty Mututal Fire Insurance Company
23035
INSURER C : Charter Oak Fire Insurance Company
25615
Alliance Construction Solutions, LLC
INSURER D :
12789 Emerson St.
INSURER E :
INSURER F
Thornton CO 80241
COVERAGES CERTIFICATE NUMBER: 19/20 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 CONTRACTOR 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
INSD
WVD
POLICY NUMBER
MM/DDY EFF
MM DD POLICY EXP
LIMITS
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
CLAIMS -MADE ® OCCUR
DAMAGE TO REN I Er-
PREMISES Ea occurrence
$ 1,000,000
MED EXP (Any one person)
$ 10,000
$10,000 Deductible
A
TB2Z91466781029
01/01/2019
01/01/2020
PERSONAL& ADV INJURY
$ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS-COMP/OP AGG
2,000,000
5
POLICY ® PEC LOC
5
OTHER:
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
(Ea axident
$ 1,000,000
BODILY INJURY (Per person)
$
ANY AUTO
BODILY INJURY (Per accident)
$
B
OWNED SCHEDULED
AUTOS ONLY AUTOS
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
ASZ91466781019
01/01/2019
01/01/2020
PROPERTY DAMAGE
Per accident
$
$
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$ 10,000,000
A
EXCESS LIAB
[I
CLAIMS -MADE
TH7Z91466781039
01/01/2019
01/01/2020
AGGREGATE
$ 10,000,000
DED I X RETENTION $ 10,000
$
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN N
ANY PROPRIETOPUPARTNERIEXECUTIVE El
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH)
WC2-Z91-466781-059
01/01/2019
01/01/2020
PER OTH-
S TATUTE 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 below
C
Leased/Rented Equipment
TQT6606G309197COF19
01/01/2019
01/01/2020
$350,000 Limit
$1,000 Deductible
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
RE: Contractor's License A-96
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS.
PO Box 580
AUTHORIZED REPRESENTATIVE
Fort Collins CO 80522-0580 (/} jGj(t /y(t *aat,sd,
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