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HomeMy WebLinkAbout592927 HASELDEN CONSTRUCTION LLC - INSURANCE CERTIFICATE (2)P5260028002 .a►cc ►Ram CERTIFICATE OF LIABILITY INSURANCE 06/28/'2o 9YY' 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 1-303-534-4567 IMA, Inc. - Colorado Division 1705 17th St Ste 100 CONTACT NAME: . PHONE FAX AIC No): ADDRIESS: denaccountteche@imacorp.com INSURERS AFFORDING COVERAGE NAIC # Denver, CO 80202 _ INSURERA: NATIONAL FIRE INS CO OF HARTFORD(CNA) 20478 INSURED Haselden Construction, LLC INSURERS: VALLEY FORGE INS CO (CNA) 20508 INSURER CCONTINENTAL INS CO (CNA) ` 35289 INSURERD: PINNACOL ASSUR 41190 6950 South Potomac Street INSURERE: INDIAN HARBOR INS Co (XL Ins.) 36940 Centennial, CO 80112 INSURER.: HANOVER INS CO 22292 t.UVtKAtit, UI-N I IFICAT@ NI1MFIFH• ebb U7]'/B QPVIe1n1U h111aaQCD• 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 POLICYNUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMJDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Fx� OCCUR 4028808411 17111119 07/01/20 EACH OCCURRENCE § 1,000,000 PREMISES Ea oaurrence $ 1,000,000 X MED EXP (Any one person) § 15,000 PI) Dad: $10,000 PERSONAL & ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: POLICY U PRO- JET LOC GENERAL AGGREGATE — $ 2,000,000 -- PRODUCTS -COMPIOPAGG $ 2,000,000 $ OTHER: B AUTOMOBILE LIABILITY C4028808425 07/Ol/19 07/01/20 COMBINED SINGLE LIMIT COMBINED $ 1,000,000 BODILY INJURY (Per person) $ X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident ( ) $ X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident __, $ C X UMBRELLA LIAS X OCCUR 6042783626 07/01/19 07/01/20 EACH OCCURRENCE $ 10,000,000 EXCESS LIAB CLAIMS -MADE AGGREGATE $ 10,000,000 DED I X I RETENTION $ 10, 000 $ D IOFFICER/MEMBEREXCLUE WORKERSCOMPENSATION AND EMPLOYERS'LIABtLTY YIN ANYPROPRIETOR/PARTNERIEXECUTIVE [Nil NIA 4082635 CO ONLY 07/01/19 07/01/20 X STATUTE ERH E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE -EA EMPLOYEE $ 1,000,000 (Mandatory in NH) describe under Dyes, des DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 i I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) City of Fort Collins, its officers, agents and employees are included as Additional Insureds on the General, Automobile and Umbrella Liability Policies and Loss Payee on the Builders Risk Coverage if required by written contract or agreement and with respect to work performed by Insured subject to the policy terms and conditions. ,+. - 1 v1— 1.A17l.CLlftl IVIY RE: Grandview Cemetery Mausoleum Work Order Number PR-600107 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Fort Collins THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. PO BOX 580 AUTHORIZED REPRESENTATIVE Fort Collins, CO 80522 MR USA ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD michael.sheinberg 56607578