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HomeMy WebLinkAboutPROVIDENT CONSTRUCTION INC - INSURANCE CERTIFICATE (3)P526W28002 X' ACIR Ir f� V V CERTIFICATE OF LIABILITY INSURANCE DATE (MM1DDNYYY) 06/26/2015 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 1-303-534-4567 INA, Inc. - Colorado Division CONTACT NAME: PHONE FAX to,ExtIn AC No: E-MAIL denaccounttechs@imacorp.com ADDRESS: rP•com 17th Street INSURERS AFFORDING COVERAGE NAIC # Suite 100 INSURERA: CONTINENTAL INS CO (CNA) 35289 Denver, CO 80202 INSURED INSURERB: CONTINENTAL CAS CO (CNA) 20443 Provident Construction Inc. INSURERC: PINNACOL ASSUR 41190 INSURER D: TRAVELERS PROP CAS CO OF AMER _ 25674 12424 E. Weaver Place INSURER E : 1 INSURER F: Centennial, CO 80111 COVFRAII CFRTIFICATF RIIMRFR- 164HA71n DCV1Q1Aa1 1,111aaCCD. 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 UBR POLICY NUMBER POLICY EFF MMIDD POLICY EXP MMIDD LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR PD Ded: $1, 000 4030406812 07/01/15 i 07/01/16 EACH OCCURRENCE $ 1,000,000 MA TO RENTED PREMISES Ea occurrence $ 300, 000 X GEN'L MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 AGGREGATE LIMIT APPLIES PER: POLICY JERCT LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ A AUTOMOBILELIABILITY X X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS fX AUTOS 4030406907 07/01/15 07/01/16 COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY Per accident ( ) $ PROPERTY DAMAGE Per accident $ B X UMBRELLALUIB EXCESS LIAB X OCCUR CLAIMS -MADE 5093395672 07/01/15 07/01/16 I EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 DIED X RETENTION$ 10,000 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? IN I (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A 4076735-COLORADO 07/O1/15 07/O1/16 X PER OTH- STATUTE ER E.L. EACH ACCIDENT _ $ 1, 000, 000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 D Leased & Rented Equipment QT6600770C134TIL15 07/01/15 07/01/16 Deductible $500 Limit $50,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) v Lf�nr rVMI I IVN 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, Attn: Ann Chantler P. 0. BOX 580 AUTHORIZED REPRESENTATIVE ZIR Fort Collins, CO 80522 /USA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD njones2014 44368730