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HomeMy WebLinkAbout150588 WALSH CONSTRUCTION INC - INSURANCE CERTIFICATE (20)OP ID: SLS A�oRO CERTIFICATE OF LIABILITY INSURANCE D05/08/201ATE YY) 05/08/2019 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 CONTACT Front Range Insurance Group PHONE FAX 2002 Caribou Drive, Ste. 101 A/c No Ext : a/c No): Fort Collins, CO 80525 E-MAIL David A. Wooldridge LUTCFAAI ADDRESS PRODUCER r11CTnMF0 1r1 i - WALSH-4 INSURER(S) AFFORDING COVERAGE NAIC # INSURED Walsh Construction, Inc. INSURER A:Pinnacol Assurance 41190 Matthew Walsh, Pres. 8139 Open View Place INSURER B : Bitco General Insurance Corp Loveland, CO 80537 INSURER C : Western World Insurance Group INSURER D : INSURER E : INSURER F Cr1VFRAr.FR rFRTIFICATF NI IMRFR• RFVISIr1N 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. R ILTR TYPE OF INSURANCE ADDL UB POLICY NUMBER MM DD/YYYY) (MM/DDNYYYJ LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 DAMAGE TO RENTED PREMISES Ea occurrence $ 300,00 B X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 1_x7 OCCUR X CLP 3 670 670 07/01/2018 07/01/2019 MED EXP (Any one person) $ 10,00 PERSONAL & ADV INJURY $ 1,000,00 C X Pollution Liab AHSECC12316-00 09/22/2018 09/22/2019 X RailRoad Liab GENERAL AGGREGATE $ 2,000,00 B CLP 3 670 670 07/01/2018 07/01/2019 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OPAGG $ 2,000,00 PRO LOC POLICY X JECT $ 1,000,00 Poll Liab B AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED AUTOS X CAP 3 670 671 CAP 3 670 671 07/0112018 07/01/2018 07/01/2019 07/01/2019 CO BtINEDSINGLE LIMIT (Eaa $ 1,000,000 BODILY INJURY (Per person) $ X BODILY INJURY (Per accident) $ ISCHEDULED X AUTOS HIREDAUTOS CAP 3 670 671 07/01/2018 07/01/2019 PROPERTY DAMAGE (PER ACCIDENT) $ X NON -OWNED AUTOS CAP 3 670 671 07/01/2018 07/01/2019 Comp Deduct $ 50 Coll Deduct $ 50 X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 3,000,00 AGGREGATE $ 3,000,00 B EXCESS LIAB CLAIMS -MADE CUP 2 814 437 07/01/2018 07/01/2019 DEDUCTIBLE $ $ RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? F—] (Mandatory in NH) N / A X 4104361 05/01/2019 05/01/2020 WC STATU- X OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYEE $ 1,000,00( If Yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 1,000,00 B contractors Equip CLP 3 670 670 07/01/2018 07/01/2019 Inst Floa 353,00 Leas/Rent 250,00 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) As respects the City. of Fort Collins, State of Colorado, M.A. Mortenson Company and Woodward Inc subcontractor's operations on this protect, the City of Fort Collins, State of G'olorado, M. A. Mortenson Company and Woodward Inc are Included as additional Insureds under the General Liability, CITYFC2 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. 300 Laporte Ave Fort Collins, CO 80522 AUTHORIZED REPRESENTATIVE G. © 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD