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HomeMy WebLinkAbout540197 NORTHWESTERN RAILROAD CONSTRUCTION INC - INSURANCE CERTIFICATE (3)CERTIFICATE OF LIABILITY INSURANCE I " 6/17/2020 06/, 6/2020 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 CERTIFICATE1HOLDER. 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 policles may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in, lieu of such endorsement(s)._ PRODUCER NAMENTA T Moody insurance Agency : Moody Insurance Agency, Inc. PNONN Exc ; (303) 824-6600 ac Na(303) 370-0118 8055 East Tufts Avenue E4=L certrequest@moodyins.com .ADDRESS:.. Suite 1000 INSURER(S) AFFORDING COVERAGE. _ _ _ _ NAIC # _ Denver CO 80237 ,uQ110=0A: Hartford Fire Insurance Co 19682 Northwestern Railroad Construction Inc 7480 Johnson Drive 25674 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCELISTEDBELOVPH7N'E'BEENISSUED TO THE INSURED -NAMED-ABOVE f FOR THEPOLICY PERIOD INDICATED. NOTWITHSTANDINGANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 INSD INVD - - -- -- POLICYNUMBER - POLICY EF.F MMIDD .POLICY EXP. MMIDDIYYYY - - LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE E 11000,000 © A 300,000 CLAIMS -MADE OCCUR PREMISES Eaoccurrence E MED EXP (Any one person) E 10,000 PERSONAL & ADV INJURY E 1,000,000 A 21UUNQZ5060 12/31/2019 12/31/2020 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE E 2,000,006 ❑ JET 2,000,000 POLICY LOC PRODUCTS -COMPIOPAGG E $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident E 1,000,000 X BODILY INJURY (Par parson) .E ANYAUTO A OWNED SCHEDULED 21UUNQZ506O 12/31/2019 12/31/2020 BODILY INJURY (Per accident) E AUTOS ONLY AUTOS PROPERTY DAMAGE E HIRED NON -OWNED AUTOS ONLY AUTO_ S ONLY Per accident E UMBRELLA LIAR OCCUR EACH OCCURRENCE E 2,000,000 11 AGGREGATE E 2,000,000 B EXCESS UA6 CLAIMS MADE 21HHU75348 12/31/2019 12/31/2020 DED I X RETENTION E 10,000 E WORKERS COMPENSATION X ERH AND EMPLOYERS' LIABIUTY Y I N STATUTE E.L. EACH ACCIDENT E 1,000,000 C ANY ER/EXECUTIVE ❑ NIA 4051981 07/01/2020 07101/202, 1,000,000 EXCLUDED't CERIMEMBEREXCL In NH) (ManOztory In NH) (Mandatory E.L. DISEASE -EA EMPLOYEE E If Yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -. POLICY LIMIT -E 1,000,000 Maxiumum Amount s659,000 Contractors Equipment D QT6SO4I152327TIL19 12/31/2019 12/31tml) DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Addldorial Remarks Schedule, maybe attached If more space Is mquhedl CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BEDELIVERED IN City of Ft. Collins ACCORDANCE WfTHTHE POLICY PROVISIONS. PO Box 560 AUTHORIZED REPRESENTATIVE Ft. Collins L.0 60522 01911118-2015 ACORD CORPORATION. All rights reserved. ACORD 25{2016/03) The ACORD ame and logo are registered marks of ACORD ACOR& 161.� AGENCY CUSTOMER ID: 00038136 LOC #: ADDITIONAL REMARKS SCHEDULE Page _ of AGENCY Moody Insurance Agency, Inc. NAMED INSURED Northwestern Railroad Construction Inc _ POUCY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance: Notes CONTRACTUAL LIABIUTYAPPLIES PER POLICY TERMS AND CONDITIONS. 03 13 06 11 Form Attached Includes: irty (30).days in advance notice of cancellation, ten (10) days for 03130611. of premium, will be given to certificate holders to the extent provided in form Ieral Liability: 00 01 09 16 Form Attached Includes: iket Additional Insured status applies only to the extent provided in form HG 00 01 09 16 when required by written contract. iket Waiver of Subrogation applies only to the extent provided in form HG 00.01 09 16 when required by written contract. iary and Non -Contributory status only to the extent provided in form HG 00 01 09 16 when required by written contract. Liability: 99 13 01 87 Form Attached Includes: 1ketAdditional Insured status applies only to the extent provided in iket Waiver of Subrogation applies only to the extent provided in fc 16 03 12 Form Attached Includes: y and Non -Contributory status only to the extent provided in 70 10 01 Form Attached: age for Certain Operations In Connection With Railroads IA 99 13 0187 when required by written contract. 99 13 01 87 when required by written contract. HA 99 16 03 12 when required by written contract. a Liability: 03 09 16 Form Attached Includes: :t Additional Insured status applies only to the extent provided in form XL 00 03 09 16 when required by written contract. It Waiver of subrogation applies only to the extent provided in form XL 00 03 09 16 when required by written contract. 09 PP Y P ... is Compensation: From Attached Includes Blanket Waiver of Subrogation. Status applies when required by written contract. Inland Marine: CM TS 60 01 10 Form Attached Includes: Blanket Loss Payees applies only to the extent provided in form CM T6 60 01 10 when required by written contract. IMPORTANT: The policy forms referenced will be sent via email only. To obtain please send your request with the email address to cerlrequest@moodyins.com The ACORD LoyZ41kL[K•]:irl and logo are registered marks of ACORD