HomeMy WebLinkAbout109420 HYDRO CONSTRUCTION - INSURANCE CERTIFICATE (4)CERTIFICATE OF LIABILITY INSURANCE
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DATE (MM/DD/YYYY)
01 /09/2019
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 Dana Stewart, CIC, CISR
NAME:
Flood and Peterson
PHONE (g70) 266-7149 FAx (970) 506-6845
.ICNo Ext : FAXNo):
PO Box 578
E-MAIL s: DStewart@floodpeterson.com
ADDRE
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURER A : Phoenix Insurance Company
25623
Greeley CO 80632
INSURED
INSURER B : Travelers Indemnity Company
25658
Hydro Construction Company Inc.
INSURER C : Travelers Property Casualty Company of America
25674
INSURER D : Pinnacol Assurance
41190
77 NW Frontage Road
INSURER E :
Fort Collins CO 80524
INSURER F :
COVERAGES CERTIFICATE NUMBER: GL/AU/XS/WC x4/19 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 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.
ILTR
TYPE OF INSURANCE
INSD
WVD
POLICY NUMBER
MMIDDY/YYYY
MMI DfYYYY
LIMITS
X
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
CLAIMS -MADE OCCUR
PREMISEEoccTurrence
$ 300,000
MED EXP (Any one person)
$ 10,000
PERSONAL & ADV INJURY
$ 1,000,000
A
Y
DT-CO-8G990899-PHX-18
04/01/2018
04/01/2019
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 2,000,000
POLICY 7 PE� LOC
PRODUCTS - COMP/OP AGG
$ 2,000,000
$
OTHER:
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
Ea accident
$ 1,000,000
X
BODILY INJURY (Per person)
$
ANY AUTO
B
OWNED SCHEDULED
AUTOS ONLY AUTOS
Y
DT-810-8G990899-IND-18
04/01/2018
04/01/2019
BODILY INJURY (Per accident)
$
X
HIRED IXNON-OWNED
AUTOS ONLY AUTOS ONLY
PROPERTY DAMAGE
Per accident
$
X
UMBRELLA LAB
X
OCCUR
EACH OCCURRENCE
$ 10,000,000
AGGREGATE
$ 10,000,000
O
EXCESS LIAR i
CLAIMS -MADE
Y
CUP-2J40080A-18-26
04/01/2018
04/01/2019
DED I X1 RETENTION $ 10,000
$
D
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE YIN
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH)
N / A
2091550
04/01/2018
04/01/2019
X PER OTH-
STATUTE ER
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
if yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE -POLICY LIMIT
$ 1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
RE: H-WRF-2019-01 - DWRF Digester 612 Lid Construction, 3036 Environmental Dr, Fort Collins CO 80521
City of Fort Collins is included as Additional Insured on the General, Automobile, and Umbrella Liability Policies if required by written contract or agreement
and with respect to work performed by Insured subject to the policy terms and conditions.
CERTIFICATE HOLDER CANCELLATION
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.
700 Wood Street
AUTHORIZED REPRESENTATIVE
Fort Collins CO 80521-1945
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