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HomeMy WebLinkAboutPROVIDENT CONSTRUCTION INC - INSURANCE CERTIFICATE (2)111 1"11 121111„ ACC)RO" CERTIFICATE OF LIABILITY INSURANCE O��02�20019 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 No: ADORES& denacccuntteche0lmacory.cam 1705 17th St Ste 100 INSURER(Sl AFFORDING COVERAGE NAIC 0 INSURERA: VALLEY FORGE INS CO(CNA Ins) 20508 Denver, CO 80202 INSURED INSURER B: CONTZIBIWTAL INS CO (CAA Ins) 35289 Provident Construction Inc. INBURERC: PINNACOL ASSUR 41190 INSURER O: TRAVELERS CAS & SURETY CO OF AMM 31194 12424 E. Weaver Place INSURERE: CONTINENTAL CAB CO(CNA Ins) 20443 INSURER F: Centennial, CO 80111 CrIVFRAGFF. CFRTIFICATF MIIYRFR• 55B77UU6 RNIRIrTM MIIMIRCo. 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 IN L POLICY NUMBER POLICY EFF MWDDIYYYY1 POLICY EXP IMMIDDNYYYI LIMITS A X COMMERCIAL GENERAL LIABUUTY Z E 4030406812 07/01/19 07/01/20 EACH OCCURRENCE S 1,000,000 CLAIMS -MADE FxIOCCUR DAMAGE TO RENTE15-- PREMI ES Me muncel 300,000 X MED EXP(Any onepawn) S 5,000 PD Dad: $1,000 PERSONAL&ADV INJURY S 1,000,000 GENT. AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 POLICY JEST LOC PRODUCTS -COMPIOP AGG a 2,000,000 a OTHER: A AUTOMOBLLELIABILITY X E C4030406907 07/01/19 07/01/20 COMBINED SINGLE LIMIT a c4 nt S 1,000,000 BODILY INJURY (Per person) $ Y ANY AUTO OWNED AUTOS ONLY SAUTOS CHEDULED BODILY INJURY (Pr aaWeM) S = HIRED $ NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTYDAMAGE IPer accld t $ a E Z UMBRELLA LIAB $ OCCUR Z E 5093395672 07/01/19 07/01/20 EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10, 000, 000 EXCESS LIAR CLAIMS -MADE DED X RETENTION$ 10,000 $ C WORKERS COMPENSATION AND EMPLOYERS•LIABILITY YIN ANYPROPRIETOR/PARTNERIEXECUTIVE � OFFICER/MEMBER EXCLUDED? (Mandatory In NH) NIA Z 4076735-COLORADO 07/O1/19 07/O1/20 E PER OTH- TAT�1T R E.L. EACH ACCIDENT S 1,000,000 E.L. DISEASE - EA EMPLOYE $ 1,000,000 M yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1, 000, 000 E Leased & Rented Equipment C6072400334 07/01/19 07/01/20 Limit 100,000 Deductible 500 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACOR0141, Additional Remarks Schedule, maybe attached If more apace Is required) 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. Attn: Ann Chantler P. O. Box 580 AUTHORIZED REPRESENTATIVE Fort Collins, CO 80522 USA ��/�/fl / //�/f rc0 1 ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD frapcine 36677004 TION All rinhtst raftarvprl