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Home My WebLink About127137 LA WOODWORKS INC - INSURANCE CERTIFICATE (2)ACOR�� CERTIFICATE OF LIABILITY INSURANCE DATE (MWDD/YVVY) 5/22/2019 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 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 NAME: Karole Peters Ewing -Leavitt Insurance Agency, Inc. PHONE. Ext: (970)679-7355 A/C, No: FAX (866)237-2178 4090 Clydesdale Parkway E-MAIL karole-peters@leavitt.com ADDRESS: Suite 101 INSURERS AFFORDING COVERAGE NAIC If INSURERA:Acuity A Mutual Insurance Company 14184 Loveland CO 80538 INSURED INSURER B: Pinnacol Assurance 41190 LA Woodworks Inc. INSURER C: INSURER D: 4476 Bents Drive INSURER E : INSURER F: Windsor CO 80550 COVERAGES CERTIFICATE NUMBER:19-20 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. INSR LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MM/DDNYVV POLICY EXP MM/DD/VYYV LIMITS A X COMMERCIAL GENERAL LIABILITY Z46492 6/1/2019 6/l/2020 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE ❑X OCCUR PREMISES (Ea ccurrence $ 500, 000 X MED EXP (Any one person) $ 10,000 Blkt Additional Insured X X Blkt Waiver of Subro PERSONAL & ADV INJURY $ 11000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PRO- JECT LOC PRODUCTS - COMP/OPAGG $ 2,000,000 $ OTHER I A AUTOMOBILE LIABILITY Z46492 6/l/2019 6/l/2020 COMBINED SINGLE LIMIT Ea accident $ 1,000, 000 X BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS X BODILY INJURY (Per accident) $ X NON -OWNED AUTOS HIRED AUTOS NX PROPERTY DAMAGE Per accident $ X $ Blkt Al BIkt WOS A X UMBRELLA LIAB X OCCUR Z46492 6/1/2019 6/1/2020 EACH OCCURRENCE S 5,000,000 AGGREGATE $ 5,000,000 EXCESS LIAR CLAIMS -MADE DED I X I RETENTION $ 0 $ X B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETORJPARTNER/EXECUTWE OFFICER/MEMBER EXCLUDED? N❑ N / A 4148953 Blanket Waiver of 6/1/2019 6/1/2020 X PER O TH- STATUTE ER E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 (Mandatory in NH) Subrogation included If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 A Installation Floater Z46492 6/1/2019 6/1/2020 Temporary Storage - $1,000 ded $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Utilities Service Center. Project #: 7157. AP Mountain States LLC, City of Fort Collins and others as required by contract are named additional insured on the General Liability and Auto Liability policies as regards work performed by the insured on this project. A waiver of subrogation applies in favor of the additional insureds listed above as regards the General Liability, Auto Liability and Workers, Compensation policies. CERTIFICATE HOLDER CANCELLATION City of Fort Collins PO Box 580 Fort 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. AUTHORIZED REPRESENTATIVE Karole Peters/KAPETE I / ACORD 25 (2014/01) INS025 (201401) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD