HomeMy WebLinkAboutHASELDEN CONSTRUCTION LLC - INSURANCE CERTIFICATE (4)�P52W,12xtM11 _ -
DATE(MMLDDIYYYY)
" Ac CERTIFICATE OF LIABILITY INSURANCE 06/28/2017
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 endorsement(s).
PRODUCER 1-303-534-4567 CONTACT
NAME:
IMA, Inc. - Colorado Division PHONE FAX
(AIC, No. Earl: no):
E-MAIL denaccouattechegimacorD.Com
1705 17th Street ADORE
Suite 100 _ INSURE S AFFORDING COVERAGE NAILS _
Denver, CO 80202 INSURER A: VALLEY FORGE INS CO (CNA) 20508
INSURED INSURERS: CONTINENTAL INS CO(CNA Insurance) 35289
Baselden Construction, LLC INSURER CPINNACOL ASS= 41190
6950 South Potomac Street INSURER0: _
INSURER E :
Centennial, CO 80112 INSURERF:
rnvcnwccc CFDTICICATF KIIIMIRFR• 9;n2D9519 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 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
SUER
POLK:Y NUMBER
MWD Y EFF
POLICPOLICY EXP
UMW
A
Z
COMMERCIAL GENERAL LIABILITY
CLAIMDE S-MAOCCUR
PD Deds $10, 000
C4028808411
07/01/17
07/01/18
EACHOCCURRENCE
$ 1,000,000
$ 1,000,000 _.
ERENTED
PREMIREMISESS(Ea occurrence)
E
MED EXP (Any one person)
$ 15,000
PERSONAL 6 ADV INJURY
$ 1,000,000
rEAGGREGATE LIMIT APPLIES PER
[X PRO- LOC
GENERAL AGGREGATE
$ 2,000,000
= 2.000,000JECT
PRODUCTS - COMP/OP AGG
$
A
AUTOMOBILE LIABILITY
R ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
NON -OWNED
X HIRED AUTOS X AUTOS
C4028808425
07/01/17
07/01/18
COMBINED SINGLE LIMIT
(Ea accident)
S I,000,000
BODILY INJURY (Per person)
_.
$
$
$ _..._.
- -- ----- --
$
BODILY INJURY (Per accident)
PROPERTY DAMAGE
per
B
X
UMBRELLA LIAS
EXCESS LIAB
E
OCCUR
CLAIMS -MADE
6042783626
07/01/17
07/01/18
EACH OCCURRENCE
$ 2,000,000
AGGREGATE
$ 2,000,000
DED I B I RETENTION $ 10, 000
$
C
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE YIN
OFFICER/MEMBER EXCLUDED? �
(Mandatory In NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
NIA
4082635 - CO ONLY
07/01/17
07/01/18
% PTAT EF ER— 0THER
Ea
-
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
$ 1,000,000
E.L. DISEASE - POLICY LIMIT
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101. Additional Remarks Schedule, may be attached If more space is required)
RE: Contractors License
CERTIFICATE
City Of Fort Collins
Box 580
IIFort Collins, CO 80522-0580
ACORD 25 (2014/01)
francine
50209519
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
USA / 4
IS) 1Vt5tl-ZU14 AGUKU GVKI UKA I IUIY. Ali rlgnis re5erve0
The ACORD name and logo are registered marks of ACORD
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