HomeMy WebLinkAboutPROVIDENT CONSTRUCTION INC - INSURANCE CERTIFICATE (2)111 1"11 121111„
ACC)RO" CERTIFICATE OF LIABILITY INSURANCE
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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
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ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
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