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HomeMy WebLinkAboutCAMPBELL CONSTRUCTION JD INC - INSURANCE CERTIFICATE'`�� "® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 6/26/2019 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 Angela Stephens NAME: g p R&R Insurance Services Inc PH NE xt (262) 574-7000 FAX No: (262)574-7080 ADDRIESS:angela.stephens@rrins.com N14 W23900 Stone Ridge Drive INSURERS AFFORDING COVERAGE NAIC # INSURERA:CNA Insurance Company 20443 Waukesha WI 53188 INSURED INSURER B:Ar ent- A Division of West Bend 15350 INSURERC:AmTrust Insurance 15350 Campbell Construction JD Inc INSURERD: 461 River Crest Ct INSURER E : INSURER F : Mukwonago WI 53149 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 OF INSURANCE ADDLSUBRTYPE INSD WVD POLICY NUMBER EFF D MM D/YYYY POLICYPOLICY MMDD/YYYY I LIMITS COMMERCIAL GENERAL LIABILITY 6083048571 7/1/2019 7/1/2020 EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE X� OCCUR =1 DAMAGE TO RENTE PREM SES Ea occur ante $ 100,000 X MED EXP (Any one person) $ 15,000 BLKT AI, PNC, WOS CNA74705XX-01/15 X BLKT AI PNC C/O PERSONAL & ADV INJURY $ 1,000,000 CNA75079XX-10/16 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY F_x I PRO � LOC PRODUCTS -COMP/OP AGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY 6083048604 7/1/2019 7/1/2020 COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ A X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ _ NON -OWNED X HIRED AUTOS X AUTOS $ X BLKT AI PNC X BLKT WOS CNA63359XX-04/12 X UMBRELLA LIAB X OCCUR 6083090898 7/1/2019 7/1/2020 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 51000,000 A EXCESS LIAR CLAIMS-M_ADE_. DED RETENTION $ $ B C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? F (Mandatory in NH) N/A A606014 TWC3806639 7/1/2019 7/1/2019 7/1/2020 7/1/2020 X PIER STATUTE X ORH- E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 I E.L. DISEASE - POLiCY LIMIT $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below A INLAND MARINE 6078767645 7/1/2019 7/1/2020 RENTED EQUIP 115,000 A BUILDERS RISK 6078767645 7/1/2019 7/1/2020 BUILDERS RISK NEW 5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) L,tK I WII,H I C MULUtK l,H1V l.,cLLH I IVIY City of Fort Collins 281 N. College Ave. Fort Collins, CO 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 Jason Navarro/AK302 ACORD 25 (2014/01) NS025 (201401) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD