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HomeMy WebLinkAbout467727 DRAHOTA COMMERCIAL LLC - INSURANCE CERTIFICATE (15)ACORD, CERTIFICATE OF LIABILITY INSURANCE 12/3 1/201s DATE(MM/DD/YYYY) 6/24/2015 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 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 8110 E Union Avenue Suite 700 Denver CO 80237 NAME: NEFAX A/C, No, Ext : A/C, No): E-MAIL ADDRESS: INSURER AFFORDING COVERAGE NAIC # (303) 414-6000 INSURER A: I lartford Fire Insurance Company 19682 INSURED Drahota Commercial, LLC 1324140 PO Box 272269 Fort Collins, CO 80527 INSURER B : Plnnacol Assurance INSURER C : Navigators Insurance Com anv 42307 INSURER D : INSURER E : INSURER F : COVERAGES DRA0001 CERTIFICATE NUMBER: 11408202 REVISION NUMBER: XXXXXXX 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. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR Y N 34ULNQT9873 12/31/2014 12/31/2015 EACH OCCURRENCE 1,000,000 PREMISES (ETO a orccur ence) $ 300,000 MED EXP Any oneperson) 10,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. POLICY JJECT XLOC OTHER GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO AUTOS NED AUTOSULEDBODILY NON OWNED HIRED AUTOS X AUTOS Y N 34UENQT9874 12/31/2014 12/31/2015 (COaBINEDtSINGLE LIMIT $ 1,000 OOO BODILY INJURY (Per person) $ XXXXXXX Ix INJURY (Per accident $ XXXXXXX PROPERTYDAMAGE Per accident $ XXXXXXX $XXXXXXX C UMBRELLA LIAB EXCESS LIAB NOCCUR CLAIMS -MADE Y N SE14EXC7418871V 12/31/2014 12/31/2015 EACH OCCURRENCE $ 10,000,000 X AGGREGATE $ 10,000,000 DED RETENTION $ $ XXXXXXX H WORKERS COMPENSATION AND EMPLOYERS' LABILIITY YIN ANY OFFICER/MEM ER EXCLUDED? PROPRIETOR/PARTNER/EXECUTIVE N❑ in and If yes describe If yes tlescnDe under DESCRIPTION OF OPERATIONS below N / A N 2286970 7/1/2015 7/1/2016 P OTH- X I STATUTE FIR IE.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE 1 .000 000 E.L. DISEASE - POLICY LIMIT 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The City of Fort Collins and Belford Watkins Group, LLC, alonE with their respective officers, agents and employees, are included as Additional Insureds as respects Liability. ` t,tK I I1-16A I t MULUtK GANGtLLA I IUN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 11408202 AUTHORIZED REPRESENTATIVE City of Fort Collins 215 N. Mason - First Floor Fort Collins, CO 80522-0580 ACORD 25 (2014/01) ©1 R812014 ACORD CORPO ATION. All riahts reserved Thn A1`.nP 1 nnmn nnri In ern rnnicfcrnrl m—lrc of Ar"rIOn ACORD, CERTIFICATE OF LIABILITY INSURANCE 12/3 1/201 F DATE(MM/DD/YYYY) 6/24/2015 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 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 CONTACT NAME: (PA lC, No, Ext : A C, No): 8110 E Union Avenue Suite 700 Denver CO 80237 E-MAIL ADDRESS: INSURER AFFORDING COVERAGE NAIC # (303) 414-6000 INSURER A : Hartford Fire Insurance Company 19682 INSURED Drahota Commercial, LLC INSURER B : Plnnacol Assurance 1056725 PO Box 272269 Fort Collins, CO 80527 INSURER C : AGCS Marine Insurance Com anv 22837 INSURER D : Navigators Insurance Company 42307 INSURER E : INSURER F : COVERAGES DRACO01 CERTIFICATE NUMBER: 12946738 REVISION NUMBER: XXXXXXX 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. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WIND POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MMIOD/YYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY Y N 34UENQT9873 12/31/2014 l2/31/2015 EACH OCCURRENCE 1,000,000 CLAIMS -MADE � OCCUR DAMAGE REM PREMISES (ETO a RENTED ) $ 300,000 MED EXP (Any oneperson) 10,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER POLICY PRO- FX LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 210001000 1 $ OTHER A AUTOMOBILE LIABILITY Y N 34UENQT9874 12/31/2014 12/31/2015 Ea aBBIN DtSINGLE LIMIT $ 1,000,000 X BODILY INJURY (Per person) $ }Cj(X}CXXX ANY AUTO AALL UTOS NED AULED UTOS BODILY INJURY (Per accident $ XXXXXXX X PROPERTY DAMAGE Per accident $ XXXXXXX NON -OWNED HIRED AUTOS X AUTOS $XXXXXXX D UMBRELLA LIAR I X IOCCUR Y N SE14EXC7418871V 12/31/2014 12/31/2015 EACH OCCURRENCE $ 10,000 000 X AGGREGATE $ 10,000,000 EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ XXXXXXX B WORKERS COMPENSATION ANDEMPLO ERS'LABILIITY YIN AN YOFFICER//MEMBER EXCLUDED? PROPRIETOR/PARTNER/EXECUTIVE N❑ (Mandatary in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A N 2286970 7/1/2015 7/1/2016 JOTH- X STATUTE FIR E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE 1,000,000 E.L. DISEASE - POLICY LIMIT 1,000,000 C Blanket Builders Risk N N MX193055560 12/31/2014 12/31/2015 Non -Frame Limit: $10,000,000 Frame Limit: $5,000,000 Deductible: $1,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Proposal - 7637 General Contractor for Fire Station Expansion & Renovation Projects, The City, its officers, agents and employees are included as additional insured as respects liability if required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 12946738 AUTHORIZED REPRESENTATIVE City of Fort Collins' Purchasing Division P.O. Box 580 Fort Collins CO 80522-0580 J C Q�/C � rtvf ACORD 25 (2014/01) ©1 8 2014 ACORD CORP0116ATION. All rights reserved The aCr1Rr1 name —1 Innn ire renicferori m 11re of arnpiri