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HomeMy WebLinkAbout113060 MOUNTAIN CONSTRUCTORS INC - INSURANCE CERTIFICATE (11)Client#: 33585 MOUCONPC ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 6/28/2017 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 Holmes Murphy - Colorado 7600 East Orchard Road, Suite 330 South Greenwood Village, CO 80111 CONTACT NAME: Pat Reece PHONE 720-622-8246 F 855-668-0069 A/C, No, Ext : A/c, No E-MAIL reece holmesmur h ADDRESS: p p y'com INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: Travelers Indemnity Company 25658 INSURED INSURER B: Travelers Property Casualty Co. 25674 Mountain Constructors, Inc. 622 Main Street INSURER C : Pinnacol Assurance Company 41190 PO Box 405 INSURER D : Platteville, CO 80651 INSURER E : INSURER F COVERAGES CERTIFICATE NUMBER: 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 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. LTR TYPE OF INSURANCE ADDLSUBR NSR WVD POLICY NUMBER MM/DD Y MM/DDrYYYy LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE I -XI OCCUR PD Ded: $1,000 X DTC0326101033217IND 7/01/2017 07/01/2018 EACH OCCURRENCE $1,000,000 PREMISESOEa occur ence $300000 X MED EXP (Any one person) $5,000 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY 7 ECOT. 7 LOC OTHER: GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP/OPAGG $2,000,000 $ B AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED X HIRED AUTOS X AUTOS X Drive Oth Car DT810326DO33217TIL 7/01/2017 07/01/201 COEaMBINED accident SINGLE LIMIT $1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ O Pera cidenDAMAGE t $ $ B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE DTSMCUP5J415805172 7/01/2017 07/01/2018 EACH OCCURRENCE $8 000 000 AGGREGATE s8,000,000 DED X RETENTION$1O 000 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/ N OFFICER/MEMBER EXCLUDED? F7N (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A 3027994 7/01/2017 07/01/201 X PER OSTATUTE TH- E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE -POLICY LIMIT $1,000,000 B B Installation Fit. Leased/Rented Eq. QT6605059R618TIL17 QT6605059R618TIL 7/01/2017 7/01/2017 07/01/201 07/01/201 $200,000; $1,000 Ded $250,000; $1,000 Ded DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Project: 8266 Timberline & Prospect Intersection Improvement As required by written contract or written agreement, the Certificate Holder is included as Additional Insured under General Liability and Automobile Liability with respect to the above referenced. City of Fort Collins P.O. Box 580 Fort Collins, CO 80522 L;ANL;tLLA 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 (2014/01) 1 Of 1 #S2923321M292290 ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD MANV1