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HomeMy WebLinkAbout592927 HASELDEN CONSTRUCTION LLC - INSURANCE CERTIFICATE (5)P526W280()2 Ii M DATE(MMIDDfYYYY) R ACa CERTIFICATE OF LIABILITY INSURANCE 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 t, BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. u O IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. r 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 CONTACT INA, Inc. - Colorado Division PHONE FAX (A/C. No): > 1705 17th St Ste 100 AD RIESS: denaccounttechs@imacorp.com W INSURERS AFFORDING COVERAGE NAIC • Denver, CO 80202 _ INSURER A: VALLEY FORGE INS CO (CNA) 20508 INSURED INSURERB: NATIONAL FIRE INS CO OF HARTFORD(CNA) 20478 Haselden Construction, LLC INSURER CCONTINENTAL INS CO (CNA) 35289 6950 South Potomac Street INSURER D: PINNACOL ASSUR 41190 INSURER E : Centennial, CO 80112 INSURER F: COVERAGES CERTIFICATE NUMBER: 56598313 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 JM JM POLICY NUMBER MMLIDY EFF MWDD POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY 4028808411 07/01/19 07/01/20 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR DAMAGE TO R ENT PREMISES Ea occurrence $ 1,000,000 X MED EXP (Anyone person) $ 15,000 PD Ded: $10, 000 PERSONAL & ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY�JECT [LOC PRODUCTS -COMPfOPAGG $ 2,000,000 OTHER: B AUTOMOBILE LIABILITY C4028808425 07/01/19 07/01/20 COMBINED S INGLE LIMIT a accident $ 1,000,000 BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS IX X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident) $ $ C X UMBRELLA LIAB X OCCUR 6042783626 07/01/19 07/01/20 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 EXCESS LIAB CLAIMS -MADE DED I X I RETENTION$ 10,000 $ D AND WORKERS COMPENSATION AND EMPLOYERS' LV181LITY ANYPROPRIETORIPARTNERIEXECUTIVE Y IaN OFFICERIMEMBEREXCLUDED? N (Mandatory In NH) NIA 4082635 - CO ONLY 07/01/19 07/01/20 PER OTH. X STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below 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, Automobil 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. The Umbrella Liability is excess of the General Liability, Automobile Liability and Employer's Liability Policies. t:tK l ltlUA I t MULUtn k AIYI,CLLA I IUIY RE: Work Order # PR-600110 City Hall ADA Upgrades. 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. 300 LaPorte Ave Fort Collins, CO 80522 USA AUTHORIZED REPRESENTATIVE 40. ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD michael.sheinberg 56598313