HomeMy WebLinkAboutPROVIDENT CONSTRUCTION INC - INSURANCE CERTIFICATE (6)P524Aa11aea12
m DATE(MM/DD/YYYYI
,4Coko 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
(A/C, N% EM-_ .__.. - (MC, No):
EMAIL 1705 17th Street ADDRESS: denaccounttechs8imacorp.cOm
Suite 100 INSURER(S) AFFORDING COVERAGE NAIC_If
Denver, CO 80202 INSURERA: CONTINENTAL INS CO (CRA) 35289
INSURED INSUP.ERB: CONTINENTAL CAS CO (CNA) 20443
Provident Construction Inc. PINNACOL ASSUR 41190
INSURER C : _ _
12424 R. Weaver Place INSURERD: TRAVELERS PROP CAS CO OF AIM 25674
INSURER E :
Centennial, CO 80111 INSURER F:
rr1V9:0Ar]FC CFRTIFICATF NIIMRFR• 50229469 RFVISION NtIMRFR-
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 ADDILTYPE OF INSURANCE INSO SUER POLICY NUMBER MMI pY EFF MMI DI IY EXP LIMITS
LTR WVD
A
Y
COMMERCIAL GENERAL LIABILITY
4030406812
07/01/17
07/01/18
EACH OCCURRENCE
$ 1,000,000
CLAIMS -MADE [ —X] OCCUR
S 300,000
MAME T0� N6 TES
PREMISES iEa occurrence
Y
MED EXP (Any one person)
PD Ded: $1, 000
$ 5,000
PERSONAL 4 ADV INJURY
i 1,000,000
GENT AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 2,000,000
_ POLICY [�IPRD- LOC
PRODUCTS - COMP/OP AGG
= 2, 000, 000JECT _
OTHER
$
A
AUTOMOBILE LIABILITY
_
4030406907
07/01/17
07/01/18
COMBINED SINGLE LIMIT
Ea accident)
= 1,000,000
BODILY INJURY (Per parson)
_
S
Y ANY AUTO
BODILY INJURY (Per accident)
ALL OWNED SCHEDULED
AUTOS _ AUTOS
NON -OWNED
Y HIRED AUTOS Y AUTOS
$
S _
-
PROPERTY DAMAGE
Per accident
S
B
Y
UMBRELLALIAB
Y
OCCUR
07/01/17
07/01/10
EACH OCCURRENCE
$ 5,000,000
AGGREGATE
EXCESSLUB
CLAIMS -MADE
�5093395672
f 5.000,000
DED I Y I RETENTION$ 10,000
$
C
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE �
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH)
N / A
4076735-COLORADO
07/01/17
07/01/18
Y STT UT ER
E.L. EACH ACCIDENT
S 1,000,000
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
E.L. DISEASE - POLICY LIMIT
S 1, 000, 000
If yes, describe under
DESCRIPTION OF OPERAI IONS below
D
Leased & Rented Equipment
QT660077OC134TIL17
07/01/17
07/01/18
Deductible $ 500
Limit $50,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if mom space is required)
GtK 1 IFIUA I It MULUtK %,AF1-r-LLfi I IVn
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Fort Collins THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
Attn: Ann Chantler
P. 0. Box 580 AUTHORIZED REPRESENTATIVE
Fort Collins, CO 80522 /1W USA [[[
U 1988-2014 ACORD GUKPURAI IUN. All rights reserved.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
sp®aestas
50229469
WLL
N
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