Loading...
HomeMy WebLinkAboutCONSTRUCTION CONCEPTS INC - INSURANCE CERTIFICATE (5)ACo ® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) ll..� 1 6/29/2017 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 endorsements . PRODUCER CONTACT Karole Peters NAME Ewing -Leavitt Insurance Agency, Inc. PH( ONN E (970)679-7355 No): 4090 Clydesdale Parkway AIL ADDRESS: karole-peters@leavitt.com Suite 101 INSURERS AFFORDING COVERAGE NAIC S Loveland CO 80538 INSURERA:Cincinnati Insurance Co 10677 INSURED INSURER B :Pinnacol Assurance 41190 Construction Concepts Inc INSURER CAtlantic Specialty Insurance 27154 14125 Mead Street I Longmont CO 80504 1 INSURER F • E=_� COVERAGES CFRTIFIr ATF All IUQF:0•1 7-1 R Wr oC11101nki ui 1AAn . 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 I POLICY EXP - - -- LTR TYPE OF INSURANCE imqn wyn POLICY NUMBER LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR EPP0162368 10/1/2016 10/1/2017 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES fEa occurrence) $ 500,000 X MED EXP (Any one person $ 10,000 Blkt Additional Insured X X Blkt Waiver of Subro PERSONAL BADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY L"" J ECT LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: A AUTOMOBILE LIABILITY EPP0162368 10/1/2016 10/1/2017 COMBINED SINGLE LIMIT Ea ccident a $ 1,000,000 X BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS X $ BODILY INJURY Per accident ( ) HIRED AUTOS X NON -OWNED AUTOS X PROPERTY DAMAGE Per accident $ X _ $ Blkt Al X Blkt WOS A X UMBRELLA LIAB X OCCUR EPP0162368 10/1/2016 10/l/2017 EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 EXCESS LIAB CLAIMS -MADE DED I X I RETENTION 0 $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECU I NE OFFICER/MEMBER EXCLUDED? N / A 4031745 Blanket Waiver of 7/1/2017 7/1/2018 X PER OTH- TATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE $ 1,000,000 (Mandatory in NH) tf es, describe under DESCRIPTION OF OPERATIONS below Subrogation E.L. DISEASE - POLICY LIMIT $ 1,000,000 C Builders Risk - Reporting 790-01-03-05-0005 10/1/2016 10/1/2017 Any one structure ($1,000 ded) $1,500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Oak Street Restrooms. The City of Fort Collins is named as additional insured on the general liability and auto liability as regards work performed by the insured per written agreement. n%,M 1 C. nULUCI[ City of Fort Collins 214 North Mason Street 2nd Floor Fort Collins, CO 8OS24 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 role Peters/KAPETE U 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD IAIRMS nn­­ ,AC"R" CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 6/29/2017 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 endorsements . PRODUCER CONTACT Karole Peters Ewing -Leavitt Insurance Agency, Inc. PHONE (970) 679-7355 FAX (866)237-2178 ac No : 4090 Clydesdale Parkway ADDRIESS:karole-peters@leavitt.com Suite 101 INSURERS AFFORDING COVERAGE NAIC 0 Loveland CO 80538 INSURERA:Cincinnati Insurance Co 10677 INSURED INSURER B :Pinnacol Assurance 41190 Construction Concepts Inc INSURER CAtlantic Specialty Insurance 27154 14125 Mead Street Longmont CO 80504 I INSURER F COVERAGES rFRTIFICATF NI IMRFP-17-18 WC Dc%1IC1nd1 kii IKAMOM. 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 ADDUSUBR POLICY NUMBER ' POLICY EFF POLICY EXP M 10/l/2017 LIMITS EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑X OCCUR EPP0162368 10/1/2016 DAMAGE TO RENTED PREMISES Ea occurrence $ 500,000 X MED EXP (Any one person) $ 10,000 Blkt Additional Insured X Blkt Waiver of Subro PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: Fy� PRO - POLICY ECT 7 LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS -COMP/OP AGG $ 2,000,000 $ OTHER: A AUTOMOBILE LIABILITY EPP0162368 10/1/2016 10/l/2017 COMBINED SINGLE LIMIT a Ea ccident $ 1,000,000 X 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 $ X $ Blkt Al X Blkt WOS A X UMBRELLA LIAB X OCCUR EPP0162368 10/1/2016 10/l/2017 EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 EXCESS LIAB CLAIMS -MADE DE D X RETENTION $ 0 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? N I A 4031745 Blanket Waiver of 7/l/2017 7/1/2018 X IPER OTH- TATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE $ 1,000,000 (Mandatory in NH) If yes, describe under Subrogation E.L. DISEASE - POLICY LIMIT $ 11000,000 DESCRIPTION OF OPERATIONS below C Builders Risk - Reporting 790-01-03-05-0005 10/1/2016 10/1/2017 Any one structure ($1,000 ded) $1 , 500 , 000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) %,r-r% 1 Ir11-M I C nvurcrc L;ANGtLLA I IUN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Fort Collins THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Purchasing Division ACCORDANCE WITH THE POLICY PROVISIONS. 215 N. Mason Street 2nd Floor AUTHORIZED REPRESENTATIVE Fort Collins, CO 80524 Karole Peters/KAPETE © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INRn9S I—AnIl