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HomeMy WebLinkAboutROCHE CONSTRUCTORS INC - INSURANCE CERTIFICATE (3)A(;UHD, CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 1/1/2017 1 12/29/2015 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 Lockton Companies 8110 E. Union Avenue Suite 700 Denver CO 80237 NAME: HONE FU A JC,No, EXt : A/C, No): E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC # (303) 414-6000 INSURER A: Valley Fore Insurance Company 20508 INSURED Roche Constructors, Inc. 1358603 361 71st Avenue Greeley CO 80634 INSURER B : The Continental Insurance Company 35289 INSURER C : Continental Casualty Company 20443 INSURER D ; National Fire Insurance Co of Hartford 2047$ INSURER E : INSURER F : COVERAGES ROCC000 CERTIFICATE NUMBER: 1234R9RR RFVIRIr)N NIIMRFR• XXXXXXX --------------------- - ------------ - 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY Y N 6016184346 I/l/2016 1/I/2017 EACH OCCURRENCE 1,000,000 CLAIMS -MADE FX OCCUR PREMISES (Ea TO occur ence) $ 300,000 X Bl & PD De& $25,000 MED EXP (Any oneperson) 10,000 X Contractual Liab PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 F1POLICY JERCOT � LOC PRODUCTS - COMP/OP AGG $ 2,000,000 OTHER $ Ej AUTOMOBILE LIABILITY Y N 6016184394 l/l/2016 1/1/2017 CEOMaBIINEDtSINGLE LIMIT $ 1 000,000 X ANY AUTO BODILY INJURY (Per person) $ XXXXXXX ALL OWNED SCHEDULED BODILY INJURY (Per accident $ XXXXXXX( X HIRED AUTOS X AUTO -OWNED Peer accidentDAMAGE $ XXXXXXX $XXXXXXX C }� UMBRELLA LIAB [IOCCUR Y N 6016184377 1/1/2016 1/l/2017 EACH OCCURRENCE $ 1,000 000 EXCESS LIAB CLAIMS -MADE AGGREGATE $ 11000,000 DIED RETENTION $ $ XXXXXXX{ WORKERS COMPENSATION D OTH- AND EMPLO ERS' LIABILITY YIN N 6016344595 (AOS) 1/1/2016 I/l/2017 X STATUTE ER ANY OFFICER/MEMBER EXCLUDED? ECUTIVE N / A E.L. EACH ACCIDENT $ 1,000,000 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE 1,000,000 If yes, describe under nrc,P iPTION OF OPERATIONS Mow E.L. DISEASE - POLICY LIMIT It 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Block 32 Improvements. FOR EVIDENCE ONLY. City of Fort Collins is additional insured as respects General, Auto and Excess Liability if required by written contract per policy terms and conditions. Ten(10 day notice of cancellation will be given to Cert Holder for non-payment of premium. 12348988 City of Fort Collins Purchasing 215 North Mason Street, 2nd Floor Fort Collins CO 80524 ACORD 25 (2014101) V MI\ V GLLM I I V I\ 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 r C IV/ ©19 8 2014 ACORD CORPO ATION. All rights reserved The ACORD name and logo are registered marks of ACORD 12348988 City of Fort Collins Purchasing 215 North Mason Street, 2nd Floor Fort Collins CO 80524 ACORD 25 (2014101) V MI\ V GLLM I I V I\ 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 r C IV/ ©19 8 2014 ACORD CORPO ATION. All rights reserved The ACORD name and logo are registered marks of ACORD ACORD, CERTIFICATE OF LIABILITY INSURANCE I/l/2017 DATE(MM/DD/YYYY) 12/29/2015 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 Lockton Companies 8110 E. Union Avenue Suite 700 Denver CO 80237 NAME: PHONE A/C, No, Ext : A/C, No E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC # (303) 414-6000 INSURER A: Valley Fore Insurance Company 20508 INSURED Roche Constructors, Inc. INSURER B : The Continental Insurance Company 35289 1358603 36171stAvenue Greeley CO 80634 INSURERC: Continental Casualty Com anv 20443 INSURER D : National Fire Insurance Co of Hartford 20478 INSURER E : INSURER F : COVERAGES ROCC000 CERTIFICATE NUMBER: 13742864 REVISION NUMBER: XXXXXXX 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 INSD SUBR WVD POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MMIDD/YYYY LIMITS A Xr COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR Bt & PD Ded: $25,000 Y N 6016184346 1 1/1/2016 I/l/2017 EACH OCCURRENCE 1,000,000 PREMISESOEa oNcur ence 300,000 X MED EXP An one person)10,000 X Contractual Liab PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ECT X❑ LOC P1 OTHER GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ B AUTOMOBILE LIABILITY ANY AUTO ALL OW AUTOS NED AUTODULED NON OWNED HIRED AUTOS X AUTOS N N 6016184394 I/I/2016 l/1/2017 EOaBcINdEeDtSINGLE LIMIT $ ► OOOOOO X BODILY INJURY (Per person) $ XXXXXXX BODILY INJURY (Per accident $ XXXXXXX PROPERTY DAMAGE Per accident $ XXXXXXXX $XXXXXXX C X UMBRELLA LIAB EXCESS LIAR OCCUR N N 6016184377 1/1/2016 I/l/2017 EACH OCCURRENCE $ 1000,000 NCLAIMS-MADE AGGREGATE $ 1,000,000 DED RETENTION $ $ XXXXXXX D AND EMPLOERS'LABILIITY WORKERS COMPENSATION YIN ANY PROPRIETOR)PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION nF OPERATIONS below N / A N 6016344595(AOS) I/I/2016 1/1/2017 X STATUTE OTH- E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE 1,000,000 IF DISEASE - POLICY LIMIT 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Southeast Communitv Park. The Citv of Fort Collins is included as an Additional Insured as respects General Liability if required by written contract. l.tK l 11-11.A l t r1ULUtK lL ArVI.CLLA I IUIV SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 13742864 AUTHORIZED REPRESENTATIVE City of Fort Collins 215 N. Mason St. 2nd Flood PO Box 580 Fort Collins, CO 80522 C /J a,, - I�/( ACORD 25 12014/011 ©1 B812014 ACORD CORPO ATION. All rights reserved The ACORD name and logo are registered marks of ACORD