HomeMy WebLinkAbout109420 HYDRO CONSTRUCTION CO INC - INSURANCE CERTIFICATE (147)ACORO®
�,. CERTIFICATE OF LIABILITY INSURANCE
DATE (MM1DDlYYYY)
03/25/2019
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
a/CNNo Ext : (970) 266-7149 FAX
No): (970) 506-6845
E-MAIL DStewart@floodpeterson.com
ADDRESS:
PO Box 578
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURER A : Phoenix Insurance Company
25623
Greeley CO 80632
INSURED
INSURER B : Charter Oak Fire Insurance Company
25615
INSURER C : Travelers Property Casualty Company of America
25674
Hydro Construction Company Inc.
77 NW Frontage Road
INSURER D : Pinnacol Assurance
41190
INSURER E :
INSURER F
Fort Collins CO 80524
COVERAGES CERTIFICATE NUMBER: GL/AU/XS/WC x4/2020 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.
TR
TYPE OF INSURANCE
INSD
WVD
POLICY NUMBER
MM DDY EFF
MM DDlYY P
LIMITS
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
CLAIMS -MADE ®OCCUR
DAMAGE TO RENTEU30Q000
PREMISES Ea occurrence
$
MED EXP (Any one person)
$ 10,000
PERSONAL & ADV INJURY
$ 1,000,000
A
DT-CO-8G990899-PHX-19
04/01/2019
04/01/2020
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 2,000,000
POLICY PRO ❑
JECT LOC
PRODUCTS -COMPlOPAGG
2,000,000
$
$
OTHER:
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
(Ea accident
$ 1,000,000
BODILY INJURY (Per person)
$
ANY AUTO
B
OWNED SCHEDULED
AUTOS ONLY AUTOS
810-91-108491-19-26-G
04/01/2019
04/01/2020
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
Per accident
$
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
H
$
UMBRELLA LIAB
X
OCCUR
EACH OCCURRENCE
$ 10,000,000
AGGREGATE
$ 10,000,000
C
EXCESS LIAB
CLAIMS -MADE
CUP-2J40080A-19-26
04/01/2019
04/01/2020
DED I X RETENTION $ 10,000
$
D
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETOR/PARTNERIEXECUTIVE
OFFICER/MEMBER EXCLUDED? El (Mandatory In NH)
NIA
2091550
04/01/2019
04/01/2020
PER STATUTE ERH
X1
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 / LOCATIONS ! VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required)
Hydro Project#19-01-572 WTF Yard Repairs Work Order#: UWTFHydroYR020419
City of Fort Collins is included as Additional Insured as required by written contract with respects to liability arising out of work performed by the named
insured.
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
I AUTHORIZED REPRESENTATIVE
Fort Collins CO 80521
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