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HomeMy WebLinkAboutHORIZON WEST BUILDERS - INSURANCE CERTIFICATE (2)HORIWES-01 GENEVAD ,acoRv CERTIFICATE OF LIABILITY INSURANCE DATE(M'YYY) 3/2812012019 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 Diane Davis NAME: Forsberg Engerman Company an affiliate of Mountain West Insurance & PHONE FAX 303 762-1733 Financial Services, LLC (A/C, No, Ext): (303) 762-1717 pq�, No):( ) 3575 S Sherman Street AIM R SS: dianed@mtnwstcom Englewood, CO 80113 INSURERS AFFORDING COVERAGE NAIC # INSURER A: Em to er's Mutual casualty Company 21415 INSURED nus iRFR R • Pinnacol Assurance 141190 Horizon West Builders 3866 E 151st Ave Brighton, CO 80602-7787 INSURER F : rnVFRAnI=Q r_FRTIFICATF N1lUrtFR- RFVI-glnN NI IMRFR- 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXPLTR LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR Includes XCU X X20448 4/1/2019 4/1/2020 EACH OCCURRENCE $ 1,000,000 DAPREMAGE ISETO REdNTE Dnce $ 100'000 X MED EXp one $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEWL AGGREGATE LIMIT APPLIES PER: X POLICY j� LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG s S 2,000 000 A AUTOMOBILE LIABILITY X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS SSWry X AUTOS ONLY X AUTOS ONLY X 4X20448 4/1/2019 4/11W20 COMBINED SINGLE LWIT a iden 1,000,000 BODILY INJURY Per ereon _ S $ BODILY INJURY Per wddeM TY DAMAGE e0accideent A X UMBRELLA LWB EXCESS LIAB X OCCUR CLAIMS -MADE X20"8 4/1/2019 4/1/2020 EACH OCCURRENCE 3,000,000 $ 3,000,ri 000 AGGREGATE DED I I RETENTION $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y❑ (MandatEn NHR EXCLUDED? if yes, describe under DESCRIPTION OF OPERATIONS below NIA 088363 1/1/2019 1/1/2020 X PTA ORH E.L. EACH ACCIDENT 1,000,000 E.L. DISEASE - EA EMPLOYEE 1,000,000 E.L. DISEASE - POLICY LIMIT 1,000,000 A A Equipment Equipment 14X20448 4X20448 4/1/2019 4/1/2019 411/2020 4/1/2020 Leased/Rented Equip Scheduled Equip 75,000 152,211 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) Certificate holder is additional insured with respect to general liability and automobile liability coverage. liz The City of Ft Collins Purchasing Department PO Box 580 Ft Collins, CO 80522-0580 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 ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD