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Home My WebLink About501461 CONSTRUCTION CONCEPTS INC - INSURANCE CERTIFICATE (4)AlCO_RE> CERTIFICATE OF LIABILITY INSURANCE v DATE (MM/DD/YYVY) 6/25/2019 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 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 Ewing -Leavitt Insurance Agency, Inc. 4090 Clydesdale Parkway Suite 101 Loveland CO 80538 NAME: Karole Peters PHD N tC Ext: (970) 679-7355 aC, NO: AX (866)237-2178 E-MAILSS:karole-peters@leavitt.com ADDRE INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Addison Insurance Company 10324 INSURED Construction Concepts Inc 14125 Mead Street Longmont CO 80504 INSURERB:Pinnacol Assurance 41190 INSURER C:Atlantic Specialty Insurance 27154 INSURER D: INSURER E : INSURER F: COVERAGES CERTIFICATE NUMBER:19-2U WC UPDATE 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 SUER POLICY NUMBER EFF MMlD D/YVYy POLICY P MM/DD/YYYPOLICY LIMITS A X COMMERCIAL GENERAL LIABILITY 60509044 10/1/2018 10/1/2019 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR DAMAGEN PREMISES Ea occurrence $ 500,000 X MED EXP (Any one person) $ 10,000 Blkt Additional Insured X X Blkt Waiver of Subro PERSONAL &ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY F PRO7 LOC PRODUCTS - COMP/OPAGG $ 2,000,000 $ OTHER: A AUTOMOBILE LIABILITY 60509044 10/1/2018 10/1/2019 COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ X ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS X PROPERTY DAMAGE Per accide nt $ NON -OWNED AUTOS X HIRED AUTOS NX $ X Bklt Al Blkt WOS A X UMBRELLA LIAB X OCCUR 60509044 10/1/2018 10/1/2019 EACH OCCURRENCE $ 2,000, 000 AGGREGATE $ 2,000,000 EXCESS LIAB CLAIMS -MADE DEC) X RETENTION $ 0 $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y❑ OFFICERUMEMBER EXCLUDED? N / A 4031745 7/1/2019 7/1/2020 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 11000, 000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below C Builders Risk - Reporting 790-01-03-05-0007 10/1/2018 10/1/2019 Any one structure($1,000 ded) $2,500,000 A Leased/Rented Equipment 60509044 10/1/2018 10/1/2019 Limit with$1,000 ded $150,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more space is required) RE: Oak Street Restrooms. The City of Fort Collins is named as additional insured on the general liability and auto liability as regards work performed by the insured per written agreement. CERTIFICATE HOLDER CANCELLATION City of Fort Collins 214 North Mason Street 2nd Floor Fort Collins, CO 80524 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 e Peters/KAPETE ne 19RR-9nld ArORn ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (201401) ORATION. All rights reserved