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584662 ANDALE CONSTRUCTION INC - INSURANCE CERTIFICATE
ACC?R01' CERTIFICATE OF LIABILITY INSURANCE 10na020 DA9/30/DD/YYYY) 9/30/2019 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 rights to the certificate holder in lieu of such endorsement(s). PRODUCER Lockton Companies 444 W. 47th Street, Suite 900 Kansas City MO 64112-1906 (816)960-9000 CONTACT AIC No Ext : A/C Nia: E- MAIL INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: Zurich AmCncan Insurance Company 16535 INSURED ANDALE CONSTRUCTION INC. 1335165 3170 N. OHIO WICHITA KS 67219 INSURER B: Indian Harbor Insurance Com anv 36940 INSURER C : rravelers Property Casually Co of America 25674 INSURER INSURER E INSURER rn..voacvc rcortrlr ATc MI Iaaal=o- RFVISICIN NLIMBFR- XXXXXXX V 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. ILT R TYPE OF INSURANCE ANDL SUER POLICY NUMBER POLICY EFF MMIDDIYYYY IPO�ICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS-MADE0 OCCUR Y N GLOO183143-03 10/1/2019 10/1/2020 EACH OCCURRENCE S 1,000,000 DAMAGE TO RENTED PREMISE rren 100,000 MED EXP (Any oneperson) 10,000 PERSONAL & ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER. ){ POLICY JE� ExE LOC OTHER. GENERAL AGGREGATE $ 2.000,000 PRODUCTS - COMP/OP AGO $ 2,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO OS ONLY AUTOSULEDBODILY AUTOS ONLY X AUTOS ONLDD Ix N BAP0183144-03 10/1/2019 10/1/2020 CO Ea aw10ensw tGLE LIMIT $ 1000 000 BODILY INJURY (Per Person) $A INJURY (Per accident $ XX)I�CX PROPERTY DAMAGE Per accltlent $ XXXXXXX $XXXXXXX B )( UMBRELLALIAB EXCESS UAB X OCCUR CLAIMS -MADE N N SXS005272801 10/1/2019 10/I/2020 EACH OCCURRENCE $ 5,000.000 AGGREGATE $ 5,000.000 DED I I RETENTION $ $ XXXXXXx A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY OFFICER/MEMBER EXCLUDED? NEPJE ECUTIVE (Maneatory In NH) if yes, DESCRIPTION OF OPERATIONS Below NIA' N WC0183142-03 IO/I/2019 10/1/2020 X STATUTE OTI ER E.L. EACH ACCIDENT $ 1,000,000 El. DISEASE - EA EMPLOYEE 1 020,001 E.L DISEASE - POLICY LIMIT 1,000,000 C LEASED/RENTED EQUIPMENT IN I N QT-630-21-726757=fIL-19 10/1/2019 10/1/2020 $375,000 BLANKET LIMIT PER ITEM DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) THE CITY OF FORT COLLINS IS ADDITIONAL INSUREDS ON GENERAL LIABILITY AND AUTO LIABILITY, AS REQUIRED BY WRITTEN CONTRACT AND SUBJECT TO THE TERMS AND CONDITIONS OF THE POLICY. THIRTY (30) DAYS NOTICE OF CANCELLATION BY TIC INSURER WILL BE PROVIDED TO THE CERTIFICATE HOLDER, TEN (10) DAYS NOTICE IN THE EVENT OF NONPAYMENT OF PREMIUM. GtK I II-111:A 1 t rIULUtK rvlx SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 15499245 AUTHORIZED REPRESENTATIVE THE CITY OF FORT COLLINS PO BOX 580 FORT COLLINS CO 80522 Arnon'21S nmA/nz] ©1 8-2015 ACORD CORPORATION. All rights reserved The ACORD name and logo are registered marks of ACORD