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HomeMy WebLinkAboutWALSH CONSTRUCTION INC - INSURANCE CERTIFICATE (2)OP ID: SLS , 1% O CERTIFICATE OF LIABILITY INSURANCE �� D07/24ATE /2 V9 o7/za/zo1 s 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 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 Front Range Insurance Group 2002 Caribou Drive, Ste. 101 CONTACT NAME: PHONE FA A/c No xt: (IllNo: E-MAIL ADDRESS: Fort Collins, CO 80525 AssuredPartners Colorado PRODUCER WALSH-4 CUSTOMER 1 0, INSURE S AFFORDING COVERAGE NAIC N INSURED Walsh Construction, Inc. INSURER A: Plnnacol Assurance 41190 8139 Open View Place INSURER e : Bttco General Insurance Corp Loveland, CO 80537 INSURER C : Weahm World Insurance Group INSURER D INSURER E : INSURER F : r nVFRAGFS CERTIFICATE NUMBER, 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 TYPE OF INSURANCE ADDLSUBR POLICY NUMBER PO DD LICY EFF POLICY EXP IMM/DDfYYYYI LIMITS B C GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Fx_1 OCCUR X Pollution Liab X CLIP 3 670 670 HSECC12316-00 07/01/2019 09122/201B 07/01/2020 09/22/2019 EACH OCCURRENCE $ 1,000,00 PREMISESTEeoccurrence $ 300,00 MED EXP (Any one person) $ 10,00 PERSONAL S ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GENII. AGGREGATE LIMIT APPLIES PER. JrCT 1-7POLICY X PRO- LOC PRODUCTS - COMPIOP AGG $ 2,000,00 S 1,000,00 POIIUtIOn B AUTOMOBILE LIABILITY ANY AUTO ALLOWNEDAUTOS SCHEDULEDAUTOS HIRED AUTOS NON -OWNED AUTOS CAP 3 670 671 07/01/2019 07/01/2020 COMBINEDiSINGLE LIMIT Ea $ 1,000.00 $ X BODILY INJURY (Per person) BODILY INJURY (Per accident) $ - $ PROPERTY DAMAGE (PER ACCIDENT) $ $ B J( UMBRELLA LAS EXCESS UAB X OCCUR CLAIMS -MADE CUP 2 814 437 07/01/2019 07/01/2020 EACH OCCURRENCE S 3,000,00 AGGREGATE $ 3,000,00 DEDUCTIBLE RETENTION $ S 1 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN A ANYPROPRIETOR/PARTNERlEXECUTIVEF—TNIA104361 OFFICER/MEMBER EXCLUDED? ❑ (Mandatory In NH) If yes describe under DESCRIPTION OF OPERATIONS below I 05/01/2019 I 05101/2020 X7 WC TATU- I OTH- I TORY LIMITS ER E.L. EACH ACCIDENT S 1,000,00 E.L. DISEASE - EA EMPLOYE $ 1,000,00 E.L. DISEASE -POLICY LIMIT I $ 1,000,00 B Inland Marine CLIP 3 670 670 07/01/2019 07/01/2020 Inst Floa 350,00 Leas/Rent 250,00 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) City of Fort Collins is included as additional insured per conditions and forms shown on page 2. Protect: Fort Collins -Loveland Municipal Airport Snow Removal Equipment (SRE) Building L.CK I Ir It.A I C 1`1 ULUCK I.AINI CLLA I IUN CITYOFF SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Fort Collins 215 N Mason Fort Collins, CO 80522 AUTHORIZED REPRESENTATIVE © 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD