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HomeMy WebLinkAbout264477 TLM CONSTRUCTORS - INSURANCE CERTIFICATEpi2MN12NIN12 X l ,acoKr' CERTIFICATE OF LIABILITY INSURANCE I DATE06/29/2 IY29/2015 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 1-844-484-7750 Holmes Murphy & Assoc - CO CONTACT NAME_ - - - ---- - --- --- PHONE FAX t :. I (AIC, No):_ 7600 East Orchard Road, Suite 330 South - _ _ - E-MAIL ADDRESS: Greenwood Village, CO 80111 ___ INSURER(S)AFFORDING COY GE NAIC0 INSURER A: Travelers Indemnity Company IISURERB: TRAVELM IMD CO OF CT 25682 INSURED TLM Constructors, Inc. INSURER C : TRAVELERS PROP CAS INS CO 36161 _ _ INSURERD: PINNACOL ASSUR 41190 P.O. Box 336638 INSURERE: AGCS Marine Insurance Company Greeley, CO 80633 INSURER F : CAVFRAGFS CERTIFICATE NIIMRFR• 4443081A 0C%1l C1f%&l LIN IRAOCn. 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 TYPE OF INSURANCE ADOL SUBR� POLICY EFF POLICY EXP LTR I POLICY NUMBER MMIDO MMIDDIYYYY LIMITS A GENERAL LIABILITY X X DTC0326D307IND15 07/01/15 07/01/16 EACHOCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY _ CLAIMS -MADE C, OCCUR $ 300, 000 DAMAGE TO RENTED PREMISES Ea occurrence MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1, 000, 000 GENERAL AGGREGATE $ 2,000,000 GEWL AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2, 000, 000 POLICY F X PRO- LOC $ B AUTOMOBILE X LIABILITY ANY AUTO X X DT810326DO307IND15 07/01/15 07/01/16 COMBINED SINGLE LIMIT (Ea accident $1,000, 000 $ BODILY INJURY (Per person) ALL OWNED SCHEDULED AUTOS AUTOS _ BODILY INJURY (Per accident) $ X HIRED AUTOS X NON -OWNED AUTOS PROPERTY DAMAGE Per accident $ $ C X UMBRELLA LIAS OCCUR DTSMCUP326DO307TIL15 07/01/15 07/01/16 EACH OCCURRENCE $ 10,000,000 EXCESS LIAR CLAIMS -MADE AGGREGATE $ 10, 000, 000 DED X RETENTION $ 10, 000 _ _ _ _ $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETORIPARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ N I A g 4058086 10/01/14 10/01/15 g WCSTATU- OTH- Ll E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE $ 1, 000, 000 (Mandatory In NH) If yes, describe under E.L. DISEASE - POLICY LIMIT $ 1, 000, 000 DESCRIPTION OF OPERATIONS below I I E Equipment Floater MZI98476362 07/01/15 07/01/16 Scheduled EquipmentOnFile Misc. Equipment 60,000 Leased Equipment 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Project Description: Right of Way License L,r-rc i Irrl,A i s nUL LJrF% UANUtLLA 1 ILIN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ft. Collins THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 281 North College Ave. AUTHORIZED REPRESENTATIVE PO Box 580 /) n Ft. Collins,in 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 sgermer 44430818 u. 00 O C4 P52aM128W2 EPINNAACOL Denver COr80230-7006 ASSURANCE 303-361-4000 / 800-873-7242 www.pinnaeol.com NCCI #: WC000313B Policy #: 4058086 Tim Constructors Inc Willis of Colorado, Inc. Attn: Sally Sifuentes 2000 S. Colorado Blvd. PO Box 336638 Tower II, Suite 900 Greeley, CO 80633 Denver, CO 80222 (303)722-7776 ENDORSEMENT: Blanket Waiver of Subrogation We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us. This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. SCHEDULE To any person or organization when agreed to under a written contract or agreement, as defined above and with the insured, which is in effect and executed prior to any loss. Effective Date: October 1, 2014 Expires on: October 1, 2015 Pinnacol Assurance has issued this endorsement October 2, 2014. Abe Tomas Underwriter 7501 E Lowry Blvd Denver, CO 80230-7006 Page 1 of 1 P ISA - 10/02/2014 19:08:17 4058086 42287868 359-B