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HomeMy WebLinkAbout592927 HASELDEN CONSTRUCTION LLC - INSURANCE CERTIFICATE (4)P526W28002 � � l-14CQ#f.LJ CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDOtYYYY) 06/28/2019 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 1-303-534-4567 INA, Inc. - Colorado Division CONTACT NAME: PHONE FAX (A/C. No): E-MAIL denaccounttechs@imac0 ADDRESS: rp•com 1705 17th St Ste 100 INSURER 3 AFFORDING COVERAGE NAIC # INSURER A: VALLEY FORGE INS CO (CNA) 20508 Denver, CO 80202 INSURED INSURERB: NATIONAL FIRE INS CO OF HARTFORD(CNA) 20478 Haselden Construction, LLC INSURER CCONTINENTAL INS CO (CNA) 35289 INSURERD: PINNACOL ASSUR 41190 6950 South Potomac Street INSURER E : INSURER F: Centennial, CO 80112 COVERAGES CERTIFICATE NUMBER: 56598319 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. INSRLTR LTR OF INSURANCE ADDLTYPE INSD WVD SUER POLICY NUMBER MMIDDPOLICY EFF MMIDD POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY 4028808411 07/01/19 07/01/20 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR DRE TED PREMISES Ea occurrence $ 1,000,000 X MED EXP (Any one person) $ 15,000 PD Ded: $10, 000 PERSONAL & ADV INJURY $ 1,000,000 _ GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY[JEa LOC PRODUCTS -COMPIOPAGG $ 2,000,000 $ OTHER: E AUTOMOBILE LIABILITY C4028808425 07/01/19 07/01/20 COMBINEDSINGLELIMIT a Ea ccident $ 1,000,000 BODILY INJURY (Per person) $ X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTYDAMAGE Per accident $ X NON -OWNED HIRED Ix AUTOS ONLY AUTOS ONLY _ C X UMBRELLALUIB X OCCUR 6042783626 07/01/19 07/01/20 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 EXCESS LIAO CLAIMS -MADE DIED I X I RETENTION$ 101000 $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICERJMEMBER EXCLUDED? (Mandatory in NH) NIA 4082635 - CO ONLY 07/01/19 07/01/20 ERH X STATUTEYIN - _ E.L. EACH ACCIDENT $ 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 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) City of Fort Collins is included as Additional Insured on the General, Automobile and Umbrella Liability Policies if required by written contract or agreement and with respect to work performed by Insured subject to the policy terms and conditions. A Waiver of Subrogation is provided in favor of Additional Insured on the General, Automobile, Umbrella Liability and Workers Compensation Policies if required by written contract or agreement and with respect to work performed by Insured subject to the policy terms and conditions. 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 USA / �i'�/j///�J ACORD 25 (2016/03) michael.sheinberg 56598319 ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD kr �. 00 O N