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HomeMy WebLinkAboutHASELDEN CONSTRUCTION LLC - INSURANCE CERTIFICATE (2)ADATE CCO� ? CERTIFICATE OF LIABILITY INSURANCE 06/22/2015 Y) 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 1-303-534-4567 CONTACT NAME: IRA, Inc. - Colorado Division PHONE FAX (A/C, No, Ext): 1705 17th Street E-MAIL ADDRESS: denaccountteChlQima or Com D• Suite 100 _ INSURER(S) AFFORDING COVERAGE _ I NAIC 11 Denver, CO 80202 INSURERA: VALLEY FORGE INS CO (CNA) 20508 INSURED INSURERB: NATIONAL UNION FIRE INS CO OF ',19445 Haselden Construction, LLC INSURERC: PINNACOL ASSUR 41190 6950 South Potomac Street INSURER D: INSURER E : Centennial, CO 80112 INSURER F: COVERAGES CERTIFICATE NUMRER• 44281422 RFVISION NIIMRFR- 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 I AOOLISUBR POLICY EFF POLICY EXP I TYPE OF INSURANCE LIMITS LTR POLICY NUMBER MM/DD/YYYY MMIDDIYYYY A X COMMERCIAL GENERAL LIABILITY C4028808411 07/01/15 07/01/16 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTEDPREMISES (Ea occurrence $ 500,000 X PD Ded: $10,000 MED EXP (Any one person) $ 5, 000 PERSONALS ADV INJURY _ _ 000 $ 1000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY I X I JECT I X I LOC PRODUCTS-COMP/OPAGG - - $ 2,000,000 OTHER: $ A AUTOMOBILE LIABILITY C4028808425 07/01/15 07/01/16 COMBINED SINGLE LIMIT $ 1,000,000 i (Ea accident) X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ X NON -OWNED X PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) g X UMBRELLA LIAB X OCCUR BE31131563 07/01/15 07/01/16 EACH OCCURRENCE $ 2,000,000 EXCESS LIAB j 1 CLAIMS-MADE AGGREGATE $ 2,000,000 DED X RETENTION$ 10,000 $ C WORKERS COMPENSATION 4082635 - CO ONLY 07/01/15 07/01/16 X I PER STATUTE ERH AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNEWEXECUTIVE E.L. EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? N NIA (Mandatory in NH) E.L. DISEASE - EA EMPLOYE $ 500,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 500, 000 i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Contractors License U rK I11'1l,A Ir- rtULUtK t:ANL;LLLAI IUN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City Of Fort Collins THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. BOX 580 AUTHORIZED REPRESENTATIVE /.w Fort Collins, CO 80522-0580 / USA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD kbulliung 44281422