HomeMy WebLinkAbout592927 HASELDEN CONSTRUCTION LLC - INSURANCE CERTIFICATE (7)P5260028002
0
-DATE
a AC49RO 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
,
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
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REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
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IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
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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
NAME:
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IMA, Inc. - Colorado Division PHONE FAX
No:
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1705 17th St Ste 100 ADORIESS: denaccounttechs@imacorp.com
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INSURERS AFFORDING COVERAGE NAIC 0 _
Denver, CO 80202 INSURER A: VALLEY FORGE INS CO (CNA) 20508
INSURED INSURERS: 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 :
Centennial, CO 80112 1 INSURER F:
rnV1=DAr19:c rFRTIFIrATF MIIMRFR• 56598403 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.
TYPE OF INSURANCE
DDL
SUBR
POLICY NUMBER
MWDDPOLICY EFF
MWDD EXP
LIMITS
X
COMMERCIAL GENERAL LIABILITY
X
4028808411
07/01/19
07/01/20
E4CHOCCURRENCE
_11AM-AGE
$ 1,000,000
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CLAIMS -MADE Fil OCCUR
TO RENTED
PREMISES Ea occurrence
$ 1,000,000
X
MED EXP (Any one person)
$ 15,000
PD Ded: $10, 000
PERSONAL BADVINJURY
$ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS -COMP(OPAGG
$ 2,000,000
POLICYPRO 1
JECT J LOC
$
OTHER:
B
AUTOMOBILE LIABILITY
x
C4028808425
07/01/19
07/01/20
COEaMBccidentd."' SINGLE LIMIT
a
$ 1,000,000
BODILY INJURY (Per person)
$
X ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
X HIRED X NON -OWNED
AUTOS ONLY AUTOS ONLY
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
Per accident
$
C
X
UMBRELLA LIAO
X
OCCUR
6042783626
17101/19
07/01/20
EACH OCCURRENCE
$ 2,000,000
AGGREGATE
$ 2,000,000
EXCESS LIAO
CLAIMS -MADE
DED I X RETENTION$ 101000
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANYPROPRIETORIPARTNERIEXECUTIVE
OFFICERIMEMBER EXCLUDED?
(Mandatory In NH)
NIA
4082635 - CO ONLY
07/01/19
07/01/20
PERD
X STATUTE OE RH
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
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more apace is required)
The City, its officers, agents and employees are included as Additional Insureds on the General and Automobile Liabilit
Policies if required by written contract or agreement and with respect to work performed by Insured subject to the
policy terms and conditions.
RE: CFC RFP 8546 - CM/GC On -Call.
The City of Fort Collins
Attn: Purchasing Department
PO Box 580
Fort Collins, CO 80522
ACORD 25 (2016/03)
michael.sheinberg
56598403
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 ///
USA `' /�&
U1Udd-TU115 AGUKU GUKYUKAI IUN. All rlgnis reserve0.
The ACORD name and logo are registered marks of ACORD