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Home My WebLink About127137 LA WOODWORKS INC - INSURANCE CERTIFICATE (4)A� o® CERTIFICATE 'OFLIABILITY INSURANCE DATE(MMIDDIYYYY) 6/l/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 CERTIFICATE IfIOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the terms and conditions of the policy, certain policies may require certificate holder in.lie_u of -such endorsement(s). the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to an endo►sement. A statement on this certificate does not confer rights to the PRODUCER Ewing -Leavitt Insurance Agency, Inc. 4090 Clydesdale Parkway Suite 101 Loveland CO 80538 CONTACT NAME: Pam Knespel_ PHONE (970) 679-h355 I-11N 866.237.2178 AX: No E-MAADDRESS: pam-knespel@leavitt.com INSURE 3 AFFORDING COVERAGE NAIL d INSURERA. CuitY, A Mutual Insurance Company 14184 INSURED LA Woodworks Inc. 4476 Bents Drive Windsor CO 80550 INSURER B: Pinnacol Assurance 41190 INSURER C: INSURERD: INSURER E : INSURERF:. COVERAGES CERTIFICATE NUMBER:CL206105424 REVISION NUMBER: THIS IS TO CERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE. BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY 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 SUBdECTTOALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE I POLICYNUMBER POLICY EFF MMIDD/YYYY POLICY EXP MMIODNYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 .. .._ A CLAIMS -MADE DAMAGE EN TED REMISES (Ea occurrence $ 500,000 X MED EXP (Any one person) $ 30, 000 B1kt Additional Insured X Z46492 6/1/2020 6/1/2021 X Blkt Waiver of Subrogation PERSONAL 3ADVINJURY $ _ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE E. _ 2,000,000 POLICY a JECTT LOC PRODUCTS-COMP/OPAGG. $ 2,000,000 OTHER: AUTOMOBILE LIABILITY - - COMBINED SINGLE rIV17$ (Ea accident) 1,000,000 X BODILY INJURY (Per person) E A ANYAUTO _ ALL.OWNED SCHEDULED AUTOS AUTOS XNON-OWNED Z46492 6/1/2020 6/1/2021 - BODILY INJURY (Per accident) $ X PROPERTY DAMAGE Per acoldent $ AUTOS HIRED AUTOS NX X $ BIMAddllnaured BIM VMS 'X UMBRELLA LIAB °X OCCUR _ EACH.00CURRENCE $ 5 000 000 _ ..CLAIMS AGGREGATE $ 51000,000 A EXCESS LUIB -MADE. DED_ X RETENTION .$. _ - _.0.. $ X Z46492 _ _ 6/1/2020 6/1/2021 B WORKERSCOMPENSATIONH1kt AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOWPARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N❑ (Mandatory 16 NH) NIA Waiver 4148953 of 9ubso. Incl. 6/1/2020 6/1/2021 X. PER OTH- TAT TE E E.L. EACH ACCIDENT $ 1, 000, 000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, desgtbe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT. $. 11000,000 A Installation Floater Z46492 6/1/2020 6/1/2021 Temporary Swrage$1.000 Ded $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Addmorial RE.: Block 32 UAB Const Phase. A&P Job # 7106.1AP Remarks Schedule, Trey be atlacheA M more space b rapulred) Mountain States LLC, City of Fort Collins, Colorado and others as required by contract are named additional policies as regards work performed by the insured insured on the General Liability and Auto Liability on this project. A waiver of subrogation applies in favor of the additional insureds listed above as regards the General Liability, Auto Liability and Workers' Compensation policies, Ca19:� 11 y Las_\ t �: [al a a79: �a1_1, lei =1R WIN I [a], SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Fort Collins, Colorado THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO .Box. 580 J1ccoRDANCE WWiHE POLICY PROVISIONS. Fort Collins, CO 80522 AUTHORIZED REPRESENTATIVE Pam Knespel/PAKNES U 19ti6-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (2014o1)