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HomeMy WebLinkAboutASPEN HEIGHTS CONSTRUCTION LLC - INSURANCE CERTIFICATE (3)Client#: 99381 14ASPENHEI ACORD,M CERTIFICATE OF LIABILITY INSURANCE DATE (M/2015 .1../M/DD/YYYY) 7/21 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 CONTACT Shelia Moore, CIC, ACSR Wortham Insurance & Risk Mgmt. PHONE 512 453 0031 FAX 512 453-0041 A/C No Ext : A/C, No 221 West 6th Street, Suite1400 E-MAIL shelia.moore@worthaminsurance.com Austin, 7$701 AFFORDING COVERAGE NAIC # 5124INSURER(S) -0 512 53-0031 INSURERA: Ironshore Specialty Insurance C 25445 INSURED INSURER B : Starr Indemnity & Liability Corn 38318 Aspen Heights Construction, LLC INSURER C: Cincinnati Indemnity Company 23280 INSURER D : Hallmark Specialty Insurance Co 1301 S. wy, of Texas , Ste B-201 Capital H p� Austin, TX 78746 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 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 CONTRACTOR 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 LT TYPE OF INSURANCE ADDLSUBR N WVD POLICY NUMBER CY EFF /SR MMID/YYYY POLICY EXP MM /DD/YYYY LIMITS A GENERAL LIABILITY AGS0005404 7/19/2015 071191201C EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence s50,000 MED EXP (Any one person) $ 5,000 CLAIMS -MADE 51 OCCUR PERSONAL & ADV INJURY $ 1,000,000 X BI/PD Ded:5,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY PRO LOC JECT $ D AUTOMOBILE LIABILITY H4240068402 7/19/2015 07/19/2016 COMINED SINGLE LIMIT Ea acBcident $1,000,000 BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY Per accident ( ) $ X NON -OWNED HIRED AUTOS X AUTOS PROPERTY DAMAGE Per accident $ $ B UMBRELLA LIAB OCCUR 1000021994 7/19/2015 07/19/2016. EACH OCCURRENCE $1 U 00U 000 X EXCESS LIAB X CLAIMS -MADE AGGREGATE $10 000 000 DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ElN / A WC STATU- OTH- MITIER - E.L. EACH ACCIDENT $ E.L- DISEASE - EA EMPLOYEE $ (Mandatory in NH) If yes, describe under DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS below IEL C Rented/Lease Equi ENP0309056 7/19/2015 07/19/2010 $250,000 any 1 item Rented/Lease Equi ENP0309056 7/19/2015 07/19/201 $2,000,000 any 1 occ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) The General Liability policy includes a blanket additional insured endorsement that provides additional insured status to the certificate holder when there is a written contract between the named insured and the certificate holder requiring additional insured status. The General Liability and Excess Liability policy includes an endorsement providing 30 days notice of cancellation (or coverage change) will be furnished to the Certificate Holder. (See Attached Descriptions) Fort Collins Urban Renewal SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Authority ACCORDANCE WITH THE POLICY PROVISIONS. 300 LaPorte Ave PO Box 580 AUTHORIZED REPRESENTATIVE Fort Collins, CO 80522 © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) 1 of 2 The ACORD name and logo are registered marks of ACORD #S565139/M564090 14CXS DESCRIPTIONS (Continued from Page 1) The General Liability Policy includes a blanket notice of cancellation to certificate holders endorsement, providing for 30 days advance notice if the policy is cancelled by the company other than for nonpayment of premium, 10 days notice after the policy is cancelled for nonpayment of premium. Notice is sent to certificate holders with mailing address on the file with the agent or the company. The endorsement does not provide for notice of cancellation if the named insured requests cancellation. SAGITTA 25.3 (2010/05) 2 of 2 #S565139/M564090 POLICY NUMBER: AGS0005403 COMMERCIAL GENERAL LIABILITY CG 20 12 07 98 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - STATE OR POLITICAL SUBDIVISIONS - PERMITS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE State Or Political Subdivision: Whereas Required by Written Contract (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) Section II — Who Is An Insured is amended to include as an insured any state or political subdivision shown in the Schedule, subject to the following provisions: 1. This insurance applies only with respect to operations performed by you or on your behalf for which the state or political subdivision has issued a permit. 2. This insurance does not apply to: a. 'Bodily injury," "property damage" or "personal and advertising injury" arising out of operations performed for the state or municipality, or b. "Bodily injury" or "property damage" included within the "products -completed operations hazard". CG 20 12 07 98 Copyright, Insurance Services Office, Inc., 1997 Page 1 of 1 ❑