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Home My WebLink About481078 BRINKMAN CONSTRUCTION INC - INSURANCE CERTIFICATEAC:UHL), CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 2/17/2019 1 2/ 14/2018 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 Lockton Companies 8110 E. Union Avenue Suite 700 Denver CO 80237 CONTACT NAME: PHONEArc No Ext : AX No E-MAIL ADDRESS: INSURER AFFORD NCOVERAGE NAIC # (303) 414-6000 INSURER A: Liberty Mutual Fire Insurance Company 23035 INSURED Brinkman Construction, Inc. 1392944 3528 Precision Drive Suite 100 Fort Collins, CO 80528 INSURER B : First Mercury Insurance Company 10657 INSURER C : Pinnacol Assurance Company 41 190 INSURER D : Indian Harbor Insurance Company 36940 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 13359689 REVISION NUMBER- XXXXXXX 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 LTR TYPE OF INSURANCE ADDL INSD SUER WVD POLICY NUMBER POLICY EFF MM/ D/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY Y N "I B2Z91468478028 2/17/2018 2/17/2019 EACH OCCURRENCE 1 1,000,000 CLAIMS -MADE � OCCUR PRNTE REM SE TOE. occur once 100,000 MED EXP (Any oneperson) 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY JECT ❑ LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER A AUTOMOBILE LIABILITY Y N AS2Z91468478018 2/17/2018 2/17/2019 Ee aaatleDtSINGLE LIMIT $ 1 000 000 BODILY INJURY (Per person) $ XXXXXXX ANY AUTO AAUTOS ONLY SCHEDULED I BODILY INJURY (Per accident $ XXXXXXX HIRED U OS ONLY AUUTOS ONLDY PeoacedentDAMAGE $ XXXXXXX $XXXXXXX B UMBRELLA LIAB }( OCCUR N N CAEX0000061794 2/17/2018 2/17/2019 EACH OCCURRENCE $ 10,000,000 X AGGREGATE $ 10,000,000 EXCESS LIAR CLAIMS -MADE DED RETENTION $ $ XXXXXXX C WORKERS COMPENSATION AND EMPLOYERS' LABILIITY Y/N N 4197967 I/1/2019 1/1/2020 X STATUTE OER E.L. EACH ACCIDENT $ j 0OO (100 ANY OFFICER MEMBER EXCLUDED? ECU7IVEFN (t yes, d sc in NH)and If yes, tlescribe under DESCRIPTION OF OPERATIONS below N / A I I I E.L. DISEASE - EA EMPLOYEE 1,000,000 E.L. DISEASE- POLICY LIMIT 1,000,000 D Professional/Pollution N N CE07446736 1/13/2011 2/17/2019 Per Claim: $4,000,000 Aggregate: $6,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Fort Collins and Poudre Fire Authority, their officers, agents and employees are included as Additional Insured on general liability and auto liability as required by written contract with respects to liability arising out of work performed by the named insured. CERTIFICATE HOLDER CANCELLATION See Attachments SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 13359688 AUTHORIZED REPRESENTATIVE City of Fort Collins and Poudre Fire Authority P.O. Box 580 Fort Collins, CO 80522 _ ACORD 25 (2016/031 ©1988-201% ACORb CORP RATION. All riahts reserved The ACORD name and logo are registered marks of ACORD