HomeMy WebLinkAboutHALCYON CONSTRUCTION INC - INSURANCE CERTIFICATEY 11MNI1N4�11
ACOK rAJT/i MIDD/" -O
CERTIFICATE OF LIABILITY INSURANCE
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:
IN&, Inc. - Colorado Division ONE FAX PH
(A&Nti EA — AK: --- —
E-MAIL denaCCOOnttech"imacorp,Of]0
1705 17th Street ADDRESS:
Suite 100 _.- _INSURER(S)AFFORDING COVERAGE NAIC/.-.—
Denver, CO 60202 INSURERA:TRANSPORTATION INS CO (CNh) 20494
INSURED INSURERS: CONTINENTAL CAS CO (Cn&) 20443 -_--
Halcyon Construction, Inc. INSURER C CONTn=TAL INS CO (CITA) 35289
4627 W. 20th St., Suite B INSURERD: PINNACOL ASSUR _ 41190 -
-INSURER E :
Greeley, CO 80634 INSURERF:
-TI CIPATC su uaoco. Sd G6 SR6S OGVISIAM minuinFR-
vTHIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN !SSUED 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.
vast
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TYPE OF INSURANCE
ADDL
WBR
POLICY NUMBER
POLICY EFF
MMIDD
POLICY EXP
M D
LJISTS
A
X
COMMERCIAL GENERAL LIABRITY
CLAIMS -MADE �] OCCUR
BI/PD Dad: $10,000
I
6023707293
I
12/05/17
12/05/18
EACHOCCURRENCE
S 1,000,000
AMAO€_T6 RCNTE
PREMISES Ea�f
100, 000100, 000
$ 15,000
E
GEN1
MEDEXP(Arryoneperson
PERSONAL 4 ADV INJURY
f 1, 000, 000
AGGREGATE LIMIT APPLIES PER:
POLICY CJJPERO- LOC
OTHER:
GENERAL AGGREGATE
f 2,000,000
PRODUCTS -COMP/OPAGG
$ 2,000,000
_
B
AUTOMOBN.ELIABILITY
8 ANY AUTO
OWNED SCHEDULED
AUTOS ONLY _ AUTOS
HIRED NON -OWNED
E AUTOS ONLY Z AUTOS ONLY
6023707262
12/05/17
12/05/18
COMBINE ID acq*SINGLE LIMIT
$ 1,000,000
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
P
—
_
---------
S
—
C
z
UMBRELLA I"
EXCESSL1AB
z
OCCUR
CLAIMS -MADE
6023707276
12/05/17
12/05/18
EACH OCCURRENCE
$ 5,000,000
AGGREGATE
t 5,000,000
DIED I % RETENTIONS 10,000
$
D
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANYPROPRIETORIPARTNER]EXECUTIVE a
OFFICERIMEMBEREXCLUE
(Mandatory In NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
NIA
4160879
01/01/18
01/01/19
= SER TE OTH-
ER
E.L. EACH ACCIDENT
$ 1, 000, 000
E.L. DISEASE • EA EMPLOYEE
$ 1,000,000
E.L. DISEASE - POLICY LIMIT
i 1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be sdached If more space Is required)
City of Fort Collins
Water Field Operations
Fort Collins Utilities
700 Wood Street
PO Box 580
Fort Collins, CO 80521
ACORD 25 (2016/03)
SDZM
54565865
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE zo.
USA I
(V 119UU-lOTD AL:UKU UUKYUKAI IVN. All rlgnta reserveu
The ACORD name and logo are registered marks of ACORD
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