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HomeMy WebLinkAbout150588 WALSH CONSTRUCTION INC - INSURANCE CERTIFICATE (23)WALSCON-01 C3JWAGNER AFRO" DATE (MMIDDnvvY) CERTIFICATE. OF LIABILITY INSURANCE 71112020 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 T11E ISSUING INSURER(S)i AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICA, TE.HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL. INSURED, the polity(les) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION Is WAIVED, subject to the terms aAd conditions of the policy, certain policies may require an endorsement A statement an this certificate does not Confer rights to the certificate holder in lieu of such endoreement(s). PRODUCER CONTACT I NAME: Ass_uredPa_ rtners dba Front Range Ins Group F'2% /9701 222-1 ROA 80525 INSURED INSURER B : Pinnacol Assurance 41190 Walsh Construction, Inc. INSURER C : Westem World Insurance Company 13196 8139 Open View Piece INSURER D : Loveland, CO 80537 INSURER E - INSURER F : CnVFRAP.FR CERTIFICATE NiiMRFR- RFVISION NIIMRFR- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE -INSURANCE EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS AFFORDED BY THE .POLICIES. DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADD' SUBRINVID POLICY NUMBER POUCYEFF. .POLICY EXP. LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑X OCCUR X Mr 4 695 912 7/1/2020 7/1/2021 EACH OCCURRENCE $ 1,000,000 DAMAGETG aEN�TED. $ 100,000 MED EXP (Any oneperson) $ 5,000 PERSONAL B ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY lil ima LOC OTHER: GENERAL AGGREGATE $ 2,000-000 PRODUCTS -COMPIOPAGG $ 2,000,000 $ A AUTO MOBILE LIABILITY X ANY AUTO ONMED SCHEDULED AUTOSONLY AUTOS - HIgE� NO IyMS.IEp AUTOS ONLY ASVO ONLY CAP 3 6 5 913 7M/2020 7/1/2021 COMBINdE�DISINGLE LIMIT (Ea acci $ 1,000,000 BODILY INJURY Per Person)$ BODILY INJURY Per accident - $ PROPERTY DAMAGE Perarsadent $ A X_ UMBRELLA LIAR EXCESS LIAR X OCCUR CLAIMS -MADE CUP 2 8 8 011 711/2020 7/1/2921 EACH OCCURRENCE $ 3,000,000 AGGREGATE $ 3,000,000 DIED X RETENTION $ 10,000 B WORKERS COMPENSATON AND EMPLOYERS' LIABILITYER ANY PROR�Pe,RtEIETgOERRIPARTNERIEXECUTIVE YIN (ManArt in NH) EXCLUDED? (M If yes, describe under DESCRIPTION OF OPERATIONS below NIA 104361 I 511/2020 5/1/2021 X PER - OTH- E-L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE 1,000,000 $ E.L. DISEASE - POLICY LIMIT $ 1,000,000 C A Pollution Liability Leased/Rented Equip EVP100i1939-01 CLP 3 61 5.912 9/22/2019 7/1/2020 9/22/2020 7/1/2011 Occ/Agg Limit -1,000;000 250,000 DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES ACORD 701, Additional If required by written contract; the following endorsements ap' General Liability GL3084 - Additional Insured -Ongoing and Completed Operate Auto Liability APO46 - Additional Insured, Primary/Non-Contributory and waiver SEE ATTACHED ACORD 101 Remarks Schedule, my be attached Ifmom ape" Is required) Iy-on a blanket basis: o"s, Primary/Non-Contributory and waiver of subrogation of subrogation SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE iHE City of Fort. Collins ACCORDANCE WITH THE POLICY P OION DATE. VISIO SCE VMILL. BE. DELIVERED IN 215 N Mason Fort Coilins, CO 86622 AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: WALSCON-01 LOC #: 1 CUWAGNER ACOR®° 4111� ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY ssuredPartners dba Front Range Ins Group g P NAMED INSURED -- Walsh Construction, Inc. 8139 Open View Place Loveland, CO 80537 POLICY NUMBER SEE PAGE 1 CARRIER SEE PAGE 1 NAIL CODE SEE P 1 E4tcmwDATE:SEE PAGE 1 THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, ACORD.26 FORM TITLE: Certificate of Liability Insurance Description of Operations/Locations/Vehicles: Workers Compensation 3596-Waiver of Subrogation city of Fort Collins is included as additional insured per blanket conditions and forms shown above. Project: Fort Collins -Loveland Municipal Airport Snow Removal Equipment (SRE) Building ACORD 101 (2008101) © 2008 ACORD CORPORATION. All The ACORD name and logo are registered marks of ACORD