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Home My WebLink About540197 NORTHWESTERN RAILROAD CONSTRUCTION INC - INSURANCE CERTIFICATE (2)03/21/2019 Moody Insurance Agency, Inc. 8055 East Tufts Avenue Suite 1000 Denver CO 80237 Pam Thompson (303) 824-6600 (303) 370-0118 pam.thompson@moodyins.com Northwestern Railroad Construction Inc 7480 Johnson Drive Frederick CO 80504 Hartford Underwriters Insurance Company 30104 Sentinel Insurance Company, Limited 11000 Hartford Casualty Insurance Company 29424 Pinnacol Assurance 41190 Travelers Property Casualty Co of America 25674 18-19 Master A 21UUNQZ5060 12/31/2018 12/31/2019 1,000,000 300,000 10,000 1,000,000 2,000,000 2,000,000 B 21UUNQZ5060 12/31/2018 12/31/2019 1,000,000 C 10,000 21HHUQZ5348 12/31/2018 12/31/2019 4,000,000 4,000,000 D 4051981 07/01/2018 07/01/2019 1,000,000 1,000,000 1,000,000 E CONTRACTORS EQUIPMENT QT6604K152327TIL18 12/31/2018 12/31/2019 BLANKET LEASED/ $782,000 RENTED City of Ft. Collins PO Box 580 Ft. Collins CO 80522 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME: CONTACT (A/C, No): FAX E-MAIL ADDRESS: Moody Insurance Agency, Inc. Northwestern Railroad Construction Inc : Notes AUTOMOBILE PHYSICAL DAMAGE INSURANCE; Sentinel Insurance Company, Limited; NAIC #: 11000; Policy Number 21UUNQZ5060; Policy Eff 12/31/2018; Policy Exp 12/31/2019; ACV Less Deductibles, per Vehicle Schedule. CONTRACTUAL LIABILITY APPLIES PER POLICY TERMS AND CONDITIONS. IH 03 13 06 11 Form Attached Includes: Thirty (30) days in advance notice of cancellation, ten (10) days for non-payment of premium, will be given to certificate holders to the extent provided in form IH 03 13 06 11. General Liability: HG 00 01 09 16 Form Attached Includes: Blanket Additional Insured status applies only to the extent provided in form HG 00 01 09 16 when required by written contract. Blanket Waiver of Subrogation applies only to the extent provided in form HG 00 01 09 16 when required by written contract. Primary and Non-Contributory status only to the extent provided in form HG 00 01 09 16 when required by written contract. Auto Liability: HA 99 13 01 87 Form Attached Includes: Blanket Additional Insured status applies only to the extent provided in form HA 99 13 01 87 when required by written contract. Blanket Waiver of Subrogation applies only to the extent provided in form HA 99 13 01 87 when required by written contract. Auto Liability: HA 99 16 03 12 Form Attached Includes: Primary and Non-Contributory status only to the extent provided in form HA 99 16 03 12 when required by written contract. Auto: CA 20 70 10 01 Form Attached: Coverage for Certain Operations In Connection With Railroads Excess Liability: XL 00 03 09 16 Form Attached Includes: Blanket Additional Insured status applies only to the extent provided in form XL 00 03 09 16 when required by written contract. Blanket Waiver of Subrogation applies only to the extent provided in form XL 00 03 09 16 when required by written contract. Worker’s Compensation: 359-B From Attached Includes Blanket Waiver of Subrogation. Status applies when required by written contract. Inland Marine: CM T5 60 01 10 Form Attached Includes: Blanket Loss Payees applies only to the extent provided in form CM T5 60 01 10 when required by written contract. IMPORTANT: The policy forms referenced will be sent via email only. To obtain copies, please send your request with the email address to certrequest@moodyins.com ACORD 101 (2008/01) The ACORD name and logo are registered marks of ACORD © 2008 ACORD CORPORATION. All rights reserved. THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: FORM TITLE: ADDITIONAL REMARKS ADDITIONAL REMARKS SCHEDULE Page of AGENCY CUSTOMER ID: LOC #: AGENCY CARRIER NAIC CODE POLICY NUMBER NAMED INSURED EFFECTIVE DATE: PRODUCER (A/C, No, Ext): PHONE INSURED COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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. $ $ $ PROPERTY DAMAGE $ BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOS ONLY AUTOS NON-OWNED OWNED SCHEDULED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT ER OTH- STATUTE PER (MM/DD/YYYY) LIMITS POLICY EXP (MM/DD/YYYY) POLICY EFF LTR TYPE OF INSURANCE POLICY NUMBER INSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB EACH OCCURRENCE $ AGGREGATE $ $ OCCUR CLAIMS-MADE DED RETENTION $ PRODUCTS - COMP/OP AGG $ GENERAL AGGREGATE $ PERSONAL & ADV INJURY $ MED EXP (Any one person) $ EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES (Ea occurrence) $ COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY