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HomeMy WebLinkAbout386996 WESTERN STATES RECLAMATION INC - INSURANCE CERTIFICATEClient#: 33774 WESSTAPC DATE (MM/DD/YYYY) ACORD. CERTIFICATE OF LIABILITY INSURANCE 1 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 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Nick Brown Holmes Murphy - Colorado PHONE 720-458-5770 ' F4-248-0468 HONE No Ext :INC,AINo 7600 East Orchard Road, Suite 230 South -ADDRESS: nbrown@holmesmurphy.com Greenwood Village, CO 80111 INSURER(S) AFFORDING COVERAGE NAIC # INSURED Western States Reclamation, Inc. 3756 Imperial Street Frederick, CO 80516 INSURER A: Travelers Property Casualty Co. America 25674 INSURER B : Pinnacol Assurance Company 41190 INSURER C; Travelers Indemnity Co of America 25666 INSURER D : Admiral Insurance 24856 INSURER E : INSURER F : rnVFRA(;FS CFRTIFICATF NUMBFR- 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 CONTRACTOR 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. LTRR TYPE OF INSURANCE ADDLSUBR NSR WVD POLICY NUMBER POLICY MM/DIDY/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY X DTC0326DO29ATIL19 7/01/2019 07/01/2020 EACHOCCURRENCE $1,000,000 CLAIMS -MADE F OCCUR nce)s300,000 PREMISES (E. occur Dn.) X MED EXP (Any one person) $5,000 PD Ded: $2,500 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 PRO - POLICY [7X JECT 7 LOC PRODUCTS - COMP/OP AGG $2,000,000 $ OTHER: A AUTOMOBILE LIABILITY DT8102N222190TIL19 7/01/2019 07/01/202 MBINED SINGLE LIMIT (CEO, accident $1,000,000 X BODILY INJURY (Per person) $ ANY AUTO X OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY X AUTOS ONLY BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ A X UMBRELLA LIAB X OCCUR CUP6J2166661926 7/01/2019 07/01/202 EACH OCCURRENCE s5,000,000 AGGREGATE s5,0001000 EXCESS LIAB CLAIMS -MADE DED X I RETENTION $1 O 000 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROP RI ETOR/PARTNE R/EXECUTIVE Yf N OFFICER/MEMBER EXCLUDED? � (Mandatory in NH) N / A 4202787 7/01/2019 07/01/202 X PER OTH- STATUTE E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE - POLICY LIMIT $1,000,000 _ _ _LDESCRIPTION If yes, describe under OF OPERATIONS_ below _ _ _ _ _ _ Leased/Rented Eq. _ QT6602A931946TIA 7/01/2019 07/01/202 $1,000,000; $2,500 Ded C C Installation Flt. QT6602A931946TIA 7/01/2019 07/01/202 $250,000; $1,000 Ded D Pollution Liab. FEIECC1629706 7/01/2019 07/01/202 $2,000,000; $10,000 Ded DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Project Description: Landscaping Project at Horsetooth and Timberline. The Certificate Holder is an Additional Insured on the General Liability, including Completed Operations, and Business Automobile Liability, as required by written contract, per policy terms and conditions. LW_ll a;NP1a1=IV City of Fort Collins SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ty THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO Box 580 ACCORDANCE WITH THE POLICY PROVISIONS. Fort Collins, CO 80522 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S455297/M455226 MANV1