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HomeMy WebLinkAboutH W HOUSTON CONSTRUCTION LLC - INSURANCE CERTIFICATE (2)1 esaas¢mx�! ACORODATE (MMIDDNYYY) 1 CERTIFICATE OF LIABILITY INSURANCE I 09/21/2015 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($). PRODUCER 1-303-534-4567 CONTACT NAME: INA, Inc. - Colorado Division PHONE FAX 1705 17th Street Suite 100 Denver, CO 80202 INSURED N.W. Houston Construction, LLC PO Box 1463 (NS.N4.---------- -----------------J.1A/C.Nel _. ADDRESS: denaccounttecbeQimacorD.cm ADDRESS: INSURER(S) AFFORDING COVERAGE NAIL N INSURERA:TRAVELERS PROP CAS CO OF AMER 25674 INSURERS: CHARTER OAK FIRE INS CO (Travelers) 25625 INSURERC: AMERICAN GUAR & LIAB INS (Zurich) 26247 INSURERD: ZURICH ANERINS CO (Pinnacol Assurance) 16585 INSURER E : PINNILCOL ASSUR 41190 IPueblo, Co 81002 IINSURER F: I I [_nVFRAP.FA (_FRTIFlrATF MIIMRtFR• 45014784 RFVISInM MIIMRFR- 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. R ADDL 8 POLICY EFF POLICY EXP TYPE OF INSURANCE LIMITS lTR POLICY CY NIMMIDDIVYYY LT A X COMMERCIAL GENERAL LIABILITY DTC00670C701PHXIS 10/01/15 10/01/16 EACH OCCURRENCE $ 1,000,000 I X- I DAMAGES 1,000,000 _ _ CLAIMS -MADE OCCUR (RENTED PREMISES (Ea occurrence) $ X PD Deductible 1 $5, 000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 -- POLICY X i JEO- I X I LOC ---- --- PRODUCTS -COMP/OPAGG ..�--------- ----- $ 2,000,000 - OTHER: _ B AnTOMOBILELIABILITY DT8100670C701COF15 10/01/15 10/01/16 COMBINED SINGLE LIMIT $ 1,000,000 _ (Ea accident) _ _ X ANY AUTO BODILY INJURY (Per person) $ _ _ ALL OWNED i SCHEDULED BODILY INJURY (Per accident) $ ._- AUTOS AUTOS - X X NON -OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) C X UMBRELLA LIAO X OCCUR AUC931908404 10/01/15 10/01/16 EACH OCCURRENCE $ 5,000,000 EXCESS LIAR CLAIMS -MADE AGGREGATE $ 5,000,000 DIED I X 1 RETENTION $ 0 $ D WORKERS COMPENSATION WC463293206-KS,KT,NE,OK, /01/15 10/01/16 TW X STATUTE ER__ AND EMPLOYERS' LIABILITY YIN -- - - - - --------- -- E ANY PROPRIETOR/PARTNER/EXECUTIVE 4048587 - CO ONLY 10/01/15 10/01/16 El EACH ACCIDENT $ 1,000,000 OFFICERIMEMBEREXCLUDED9 a N/A --- (Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,000 B yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1, 000, 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, AddMOnal Remarks Schedule, may be attached H more space is required) CERTIFICATE HOLDER CANCELLATION RE: Contractor's License. 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. 300 La Porte AUTHORIZED REPRESENTATIVE Fort Collins, CO 80521 i USA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD kellym2013 45034784