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HomeMy WebLinkAboutWALSH CONSTRUCTION INC - INSURANCE CERTIFICATE (5)OP ID: JW1 ,d►coRO CERTIFICATE OF LIABILITY INSURANCE O07/09ATE /2019 ) 07/09/2019 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 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 Fort Collins, CO 80525 AssuredPartners Colorado CONTACT PHONE FAX AIc No. t, IAIC. No: E-MAIL ADDRESS: PRODUCER T M M:WALSH-4 CUSTOMER INSURE S AFFORDING COVERAGE NAIC 0 INSURED Walsh Construction, Inc. INSURER A: Pinnacol Assurance 41190 8139 Open View Place Loveland, CO 80537 INSURER B:BNco General Insurance Corp INSURER C : Western World Insurance Group INSURER D : INSURER E : INSURER F: COVERAGES 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 POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIDD/YYYY LIMITS B C GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR X Pollution Liab X CLP3670670 HSECC12316-00 07/01/2019 09122/2018 07/01/2020 09/22/2019 EACH OCCURRENCE 5 1,000,00 PREMISES Ea occurrence $ 300,00 $ 10,0001 MED EXP (Any one person) PERSONAL&AOVINJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PRO LOC PRODUCTS - COMP/OP AGG $ 2,000,00 Pollution S 1,000,00 B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS X CAP 3 670 671 07101/2019 07/01/2020 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,00 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (PER ACCIDENT) S $ $ B X UMBRELLA LIAR EXCESS LIAR X OCCUR CLAIMS -MADE CUP 2 814 437 07101/2019 07/01/2020 EACH OCCURRENCE $ 3,000,00 AGGREGATE $ 3,000,00 DEDUCTIBLE RETENTION $ $ S A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICERIMEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA X 104361 05/01/2019 05/01/2020 X WC STATU- OTH- - E.L. EACH ACCIDENT $ 1,000,00 E.L.DISEASE-EAEMPLOYE $ 1,000,00 E.L. DISEASE -POLICY LIMIT $ 1,000,00 B Inland Marine LP 3 670 670 07/01/2018 07/01/2019 Inst Float 350,00 Leas/Rent 250,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) As respects the City. of Fort Collins, State of Colorado, M.A. Mortenson Company and Woodward Inc subcontractor's operations on this project, the City of Fort Collins, State of G'olorado, M. A. Mortenson Company and Woodward Inc are Included as additional Insureds per conditions and forms shown on page 2 CERTIFICATE HOLDER CANCELLATION CITYFC2 City of Fort Collins 300 Laporte Ave Fort Collins, CO 80522 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 I, 2C/ . C.r�ss�aG.er is © 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD