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HomeMy WebLinkAboutLEFT HAND EXCAVATING LLC - INSURANCE CERTIFICATE (2)Client#: 33545 LEFHANPC ACORD,., CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)11/18/2015 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 CONTACT Bill Bardos NAME: Holmes Murphy - Colorado PHONE 720-622-8245 FAX 855-668-0075 A/C No Ext : A/C No 7600 East Orchard Rd, Ste 330 South E-MAIL wbardos holmesmur h tom ADDRESS: p y Greenwood Village_ CC) 80111 INSURED Left Hand Excavating, LLC 7733 N 73rd Street Longmont, CO 80503 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: QBE Insurance Corporation 39217 INSURER B : Pinnacol Assurance Company 41190 INSURER C : INSURER D : INSURER E : COVERAGES CERTIFICATE NIIMBFR: RFVISION NIIMRFR- THIS iS TO CERTIFY THAT THE POLICIES OF INSURANCE LiS T ED 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 TYPE OF INSURANCE ADDLSUB POLICY EFF POLICY EXP LIMITS LTR_ INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F x1 OCCUR PD Ded: $1,000 X CC11174022 11/17/2015 11/17/2016 EACH OCCURRENCE $1 000 000 X PREMISES ERENTED nte $100 000 MED EXP (Any one person) $10 000 X PERSONAL BADVINJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PRO LOC PRODUCTS -COMP/OP AGG $2,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS X NON -OWNED AUTOS CBA1174020 CCU1174021 11/17/2015 11/17/2015 1/01/2015 11/17/201 11/17/2016 01/01/201 aB.".nlSINGLE LIMIT Ea MINED 1,000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ X PROPERTY DAMAGE Per accident $ EACH OCCURRENCE $1000000 A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE AGGREGATE $1 000 000 DIED I X RETENTION $1 O 000 X WCSTATU- OTH- TORY LIMITS FIR $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? I N I (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A 1663960 E.L. EACH ACCIDENT $500000 E.L. DISEASE - EA EMPLOYEE $500000 E.L. DISEASE -POLICY LIMIT L50O,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Project Description: Right of Way Contractor's License The following are Additional Insureds as respects General Liability only to the extent coverage might apply according to the policy terms, conditions and exclusions. Consult the policy to determine extent of coverage. This Certificate confers no rights on the Certificate Holder. Additional Insureds: City of Fort Collins I.CRI Irit A I C rIVLUCK City of Fort Collins P O Box 580 Fort Collins, CO 80522-0580 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2010/05) 1 of 1 #S168140/M168056 ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD MANV1