HomeMy WebLinkAbout109420 HYDRO CONSTRUCTION COMPANY INC - INSURANCE CERTIFICATE (36)ACCW"® CERTIFICATE OF LIABILITY INSURANCE
°Ai0312Q/2020 q
03/20/2020
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 HOLDER.
IMPORTANT, If the certificate holder is an ADDITIONAL INSURED, the policy(iss) must have ADDITIONAL INSURED provisions or be endorsed.
ATION it SUBROGIS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on
this certificate does not confer rito the certificate holder intieu.ot,such endorsement(s).
PRODUCER
CONTACT Dana Stewart, CIC, CISR
NAME:
"PHONE --- — -(970) 266_7149 - - - - -1 AI No : (970) 506.6845
Flood and Peterson
ppDRC - DSteWart@floodpeteri�ori.com
PO Box 578
INSURERS AFFORDING COVERAGE
NAIC 0
INSURER A: Phoenix Insurance Company
25623
Greeley CO 80632
INSURED
INSURER B : Charter Oak Fire Insurance Company
25615
INSURER C: Travelers Property Casualty Company of America
25674
Hydro Construction Company Inc.
.INSURER D: Pinnacol Assurance
41190
77 NW Frontage Road
INSURER E.
INSURER.F:
Fort Collins CO 80524
COVERAGES CERTIFICATE NUMBER: GUAU/WC/XS x4/21 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 HAVESEEN. REDUCED BY PAID CLAIMS.
LTR-
TYPE OFINSURANCE
1 D
POLICY NUMBER
EFF
MWDD/YY
MOLICY ICY EXP
WDO/YY
LIMITS
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
It 1,000.000
CLAIMS -MADE ® OCCUR
PREMISES Ea occurrence
It 300,000
MED EXP Arry one non
$ 10,000
.PERSONAL AADVINJURY
:$.1,000•000
A
DT-CO-8G990899-PHX20
04/01/20.20
04/01/2021
.GEN'LAGGREGATE UMITAPPLIES PER:
GENERALAGGREGATE.
$ 2,000,000
POLICY ® JECT 7 LOC
PRODUCTS-COMP/OPAGG
$ 2,000,000
$
OTHER:
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
Ea accident)
$ 1,000,000
BODILY INJURY (Per person)
$
ANY AUTO
B
OWNED SCHEDULED
AUTOS ONLY AUTOS
810-9L108491-20.26-G
04/01/2020
04/01/2021
BODILY INJURY (Per accident)
$
DAMAGE
Per accldeni
$
HIRED NON-OWNEDPROPERTY
AUTOS
AUTOS ONLY AUTOS ONLY
$
UMBRELLAUAB
OCCUR
EACH OCCURRENCE
$ 10,000,000
AGGREGATE
$ 10,000,000
C
EXCESS LIAR
CLAIMS -MADE
CUP-2J4008OA-20-26
04/01/12020
04/01/2021
DED. RETENTION.$ 101000
_
"$
_. _. _ "_. _ __
..
D
WORKERS COMPENSATION
ANDEMPLOYERS'LJABILITY Y/N
ANY PROPRIEfOR(PARTNER(EXECUTIVE
OFFICER(MEMBEREXCLUDED?
(Mandatory in NH)
NIA
2091550
04/01/2020
04/01/2021
X PERT OTH-
.STUTE ER
E.L. EACH ACCIDENT
$ 1,000,ODO
E.L. DISEASE. EA EMPLOYEE
$ 1,000,000
If yes. describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
ESC - - _ O .._ .. ... .. - _
DESCRIPTION OFOPERATIONS /LOCATIONS /VEHICLES (ACORD 101, Addiaonsl Remarks ScfuMUM, mey he eltsehed it mero specs is required)
RE: #16-03-419/ Project# H-WRF-2016-17 DWRF - UV System Final Clarifier Covers
Certlffcate holder is included as Additional Insured as required by written contract with respecte to liability arising out of work performed by the named
insured.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOFNOTICE WILL BE DELIVERED IN
City of Fort Collins ACCORDANCE WITHTHE POLICY PROVISIONS,
300 Laporte Ave —"--_—_ ------------ —
Fort Collins CO 80522 I 1 V — l
Cc7
All riahts
ACORD 25 (2016/03)
The ACORD name and logo are registered marks of ACORD