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HomeMy WebLinkAboutPINNACLE DEVELOPMENT INC - INSURANCE CERTIFICATEACCOR" CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 4/15/2019 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 NAME: Scott Orcutt Orcutt Insurance Group, LLC FA PHONE, 33-2828 (AIC, No)A/C, NoExt : (303) 2(303) 233-6570 ADDRESS: certificates@orcuttgroup.com 965 S. Kipling Pkwy, Suite B INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Lloyds of London Lakewood CO 80226 INSURED INSURER B: Travelers 25623 PINNACLE DEVELOPMENT, INC. INSURER C : National Union Fire Insurance INSURER D : Pinnacol Assurance 41190 110 W WALNUT ST INSURER E : INSURER F : BRIGHTON CO 80601 COVERAGES CERTIFICATE NUMBER: 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. LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE FXI OCCUR PREMISES (Ea occurrence) $ 100,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 A Y WCIS-CGL-0001102-02 04/16/2019 05/30/2019 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,0K000 X POLICY F7 PRO- JECT F ] LOC PRODUCTS -COMP/OP AGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ ANY AUTO B x OWNED SCHEDULED AUTOS ONLY AUTOS BA-9544NO22 07/17/2018 07/17/2019 BODILY INJURY (Per accident) $ HIRED NON-OWNX AUTOS ONLY x AUTOS ONEDY (Per accident) $ • UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 4,000,000 AGGREGATE $ 4,000,000 C EXCESS LIAB CLAIMS -MADE EBU06483157-01 04/16/2019 05/30/2019 DED I I RETENTION $ $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? [—I Mandatory in NH) 08/01/2018 08/01 /2019 X STATUTE ER E.L. EACH ACCIDENT E.L.4059538 $ 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 Inland Marine (876) Limit $594,955 B Inland Marine (975) 1-660-8727N876 & 975-IND-IS 07/18/2018 07/18/2019 Limit $683,122 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Directional Drilling Certificate Holder is listed as Additional Insured with respect to General Liability 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. PO BOX 580 AUTHORIZED Fort Collins, CO, 80524 REPRESENTATIVE © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD