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HomeMy WebLinkAboutWALSH CONSTRUCTION INC - INSURANCE CERTIFICATE (6)-�� OP ID: SC ACORl� TE CERTIFICATE OF LIABILITY INSURANCE D0613030/12017Y) 017 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). CONTACT PRODUCER Phone: 970-223-1804 NAME: Front Range Insurance Group PHONE FAX 2002 Caribou Drive, Ste. 101 Fax: ac No Ext : A/C No): Fort Collins, CO 80525 E-MAIL ADDRESS: David A. Wooldridge LUTCFAAI PRODUCER WALSH-0 rnet . ,n e. INSURED Walsh Construction, Inc. Matthew Walsh, Pres. 8139 Open View Place Loveland, CO 80537 r_f1VFRArFC r F:PTIFIrATF NIIMRFR• INSURERS) AFFORDING COVERAGE NAIC # INSURER A: Plnnacol Assurance 41190 INSURER B: Bitco General Insurance Corp ,­„e „ . Westchester Surplus Lines Ins INSURER E : RFVISInN NIIMRFR' 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 AD L vfvn UB POLICY NUMBER POLICY MM/DD/YEYYY MM DDIYYYY LIMITS B C B GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE [XI OCCUR X Pollution Liab X CP 3 656 095 G28159079001 CP 3 656 095 07/01/2017 08/31/2016 07/01/2017 07/01/2018 08/31/2017 07/01/2018 EACH OCCURRENCE $ 1,000,00 PREMISES Eaoccurrence $ 100,00 MED EXP (Any one person) $ 5,00 PERSONAL BADV INJURY $ 1,000,00 X RailRoad Liab GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER-. POLICY X PRO LOC PRODUCTS - COMP/OP AGG $ 2,000,00 Poll Liab $ 1,000,00 B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNEDAUTOS CAP 3 656 096 CAP 3 656 096 CAP 3 656 096 CAP 3 656 096 07/01/2017 07/01/2017 07/01/2017 07/01/2017 07/01/2018 07/01/2018 07/01/2018 07/01/2018 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,00C X BODILY INJURY (Per person) $ X BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ X X Comp Deduct $ 50 Coll Deduct $ 50 F UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE CUP 2 813 295 07/01/2017 07/01/2018 EACH OCCURRENCE $ 3,000,00 X AGGREGATE $ 3,000,00 DEDUCTIBLE RETENTION $ $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVEY7 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA 4104361 05/01/2017 I 05/01/2018 WO STATU- OTH- TORY LIMIT X ER E.L.EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYEE $ 1,000,00 IE.L. DISEASE -POLICY LIMIT I $ 1,000,00 C contractors Equip CLP 3 656 095 07/01/2017 07/01/2018 �Inst Floa 353,00 Leas/Rent 100,00 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) City of Ft. Collins is listed as an Additional Insured with regards to the General Liability policy on ongoing and completed projects l.tK I II'IL.A I C I-IVLUCK t+AN1,rLL.A I IVIY CITYOFF SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Purchasing P.O. Box 580 AUTHORIZED REPRESENTATIVE Fort Collins, CO 80522 I © 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD OP ID: SC 16 O CERTIFICATE OF LIABILITY INSURANCE � DATE (30//2 Y017 06I7 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 Phone: 970-223-1804 CONTACT NAME: Front Range Insurance Group 2002 Caribou Drive, Ste. 101 Fax: PHONE FAX A/c No Ext : A/c No): E-MAIL ADDRESS: Fort Collins, CO 80525 David A. Wooldridge LUTCFAAI PRODUCER WALSH-4 CU TOMER ID #: INSURERS AFFORDING COVERAGE NAIC # INSURED Walsh Construction, Inc. INSURER A:Pinnacol Assurance 41190 Matthew Walsh, Pres. INSURER B: Bitco General Insurance Corp 8139 Open View Place Loveland, CO 80537 Westchester Surplus Lines Ins INSURER c INSURER D : 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 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 211511 WVDPOLICY NUMBER MM/DD/YYYY MMIDD/YYYY LIMITS B C B GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR X Pollution Liab X CP 3 656 095 G28159079001 CP 3 656 095 07/01/2017 08/31/2016 07/01/2017 07/01/2018 08/31/2017 07/01/2018 EACH OCCURRENCE $ 1,000,00 DAMAGE TO RENTEI� PREMISES Ea occurrence $ 100,00 MED EXP (Anyone person) $ 5,00 PERSONAL & ADV INJURY $ 1,000,00 X RailRoad Liab GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER POLICY X I PRO F LOC PRODUCTS - COMP/OP AGG $ 2,000,00 $ 1,000,00 Poll Liab B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS X CAP 3 656 096 CAP 3 656 096 CAP 3 656 096 CAP 3 656 096 07/01/2017 07101/2117 07/01/2017 07/01/2017 07/01/2018 07/01/2018 � 07/01/2018 07/01/2018 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X BODILY INJURY (Per person) $ X BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ X X Comp Deduct $ 50 Coll Deduct $ 50 F UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE CUP 2 813 295 07/01 /2017 07/01 /2018 EACH OCCURRENCE $ 3,000,00 X AGGREGATE $ 3,000,00 DEDUCTIBLE RETENTION $ $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVEY/N OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A' I 4104361 I 05/01/2017 05/01/2018 WC STATU- OTH- TORY LIMITS X ER E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYE $ 1,000,00 E.L. DISEASE -POLICY LIMIT 1 $ 1 ,000,00 C Contractors Equip CLP 3 656 095 07/01/2017 07/01/2018 Inst Floa 353,00 Leas/Rent 100,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) City of Fort Collins, it's officers, agents and employees are named as Additional Insured's with respects to the General Liability and Auto Policy Project: 8113 Remington Greenway C.FRTIFICATF HOLDER CANCELLATION CITYF05 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Fort Collins Purchasing Division 215 North Mason Street AUTHORIZED REPRESENTATIVE Fort Collins, CO 80522 © 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD OP ID: SC ACORO CERTIFICATE OF LIABILITY INSURANCE �.•--� DATE/30//2 Y01 06307 7 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 Phone: 970-223-1804 Front Range Insurance Group FdX: 2002 Caribou Drive, Ste. 101 Fort Collins, CO 80525 David A. Wooldridge LUTCFAAI CONTACT NAME: PHONE FAX AIc No Ext : AIC No): E-MAIL ADDRESS: PRODUCER WALSH-4 CUSTOMER ID #: INSURER(S) AFFORDING COVERAGE NAIC # INSURED Walsh Construction, Inc. Matthew Walsh, Pres. 8139 Open View Place Loveland, CO 80537 INSURER A: Pinnacol Assurance 41190 INSURER B: Bitco General Insurance Corp INSURER C: Westchester Surplus Lines Ins INSURER D : 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 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 OF INSURANCE ADDLTYPE INSR SUB POLICY NUMBER MM DD/YPOLICY EYYY MM / D//YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 PREMISES Ea occurrence $ 100,00 B X COMMERCIAL GENERAL LIABILITY X CP 3 656 095 07/01/2017 07/01/2018 CLAIMS -MADE 41 OCCUR MED EXP (Any one person) $ 5,00 PERSONAL BADVINJURY $ 1,000,00 C X Pollution Liab G28159079001 08/31/2016 08/31/2017 B X RailRoad Liab CP 3 656 095 07/01/2017 07/01/2018 GENERAL AGGREGATE $ 2,000,00 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,00 Poll Liab POLICY X PRO LOC $ 1,000,00 B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS X CAP 3 656 096 CAP 3 656 096 07101 /2017 07/01/2017 07/01/2018 07101 /2018 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X BODILY INJURY (Per person) $ X BODILY INJURY (Per accident) $ SCHEDULED AUTOS HIRED AUTOS CAP 3 656 096 07/01/2017 07/01/2018 PROPERTY DAMAGE (Per accident) $ X X NON -OWNED AUTOS CAP 3 656 096 07/01/2017 07/01/2018 Comp Deduct $ 50 Coll Deduct $ 50 UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 3,000,00 X AGGREGATE $ 3,000,00 F EXCESS LIAB CLAIMS -MADE CUP z 813 295 07/01/2017 07/01/2018 DEDUCTIBLE $ $ RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITYY/N ANY PROPRIETOR/PARTNER/EXECUTIVE [ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N / A X 4104361 05/01/2017 05/01/2018 WC STATu- OTH- TORY LIMITS X ER E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYEE $ 1,000,00 E.L. DISEASE -POLICY LIMIT $ 1,000,00 If yes, describe under DESCRIPTION OF OPERATIONS below C Contractors Equip CLP 3 656 095 07/01/2017 07/01/2018 Inst Floa 353,00 Leas/Rent 100,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) As respects the City of Fort Collins, State of Colorado, M.A. Mortenson Company and Woodward Inc, subcontractor's operations on this project, the Cityy of Fort Collins, State of Colorado, M. A. Mortenson Company and oodward Inc are included as additional Insureds under the General Liability, CERTIFICATE HOLDER CANCELLATION CITYFC2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Fort Collins 300 Laporte Ave Fort Collins, CO 80522 AUTHORIZED REPRESENTATIVE © 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD No Text OP ID: SC ,AcoRO CERTIFICATE OF LIABILITY INSURANCE DATE/ 06/3030/2017Y) 017 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 Phone: 970-223-1804 CONTACT NAME: Front Range Insurance Group 2002 Caribou Drive, Ste. 101 Fax: Fort Collins, CO 80525 David A. Wooldridge LUTCFAAI PHONE FAX A/c No Ext : A/c No): E-MAIL ADDRESS PRODUCER CUSTOMER ID #: WALSH-4 INSURER(S) AFFORDING COVERAGE NAIC # INSURED Walsh Construction, Inc. INSURER A: Pinnacol Assurance 41190 Matthew Walsh, Pres. INSURER B: Bltco General Insurance Corp 8139 Open View Place Loveland, CO 80537 Westchester Surplus Lines Ins INSURER C: INSURER D : 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 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 UB POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP W MM/DD/YV LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 PREMISES Ea occurrence $ 100,00 B X COMMERCIAL GENERAL LIABILITY X CP 3 656 095 07/01/2017 07/01l2018 CLAIMS -MADE FxI OCCUR MED EXP (Any one person) $ 5,00 PERSONAL &ADV INJURY $ 1,000,00 C X Pollution Liab G28159079001 08/31/2016 08/31/2017 X RailRoad Liab GENERAL AGGREGATE $ 2,000,00 B CP 3 656 095 07/01/2017 07/01/2018 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,00 PRO Ej LOG 1-7 POLICY I X1 Poll Liab $ 1,000,00 B AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED AUTOS CAP 3 656 096 CAP 3 656 096 07/01/2017 07/01/2017 07/01/2018 07/01/2018 EOMaBINdEeDiSINGLE LIMIT $ 1,000,00 BODILY INJURY (Per person) $ X BODILY INJURY (Per accident) $ SCHEDULED AUTOS HIRED AUTOS CAP 3 656 096 07/01/2017 07/01/2018 PROPERTY DAMAGE (Per accident) $ X X NON -OWNED AUTOS CAP 3656096 07/01/2017 07/01/2018 Comp Deduct $ 50 Coll Deduct $ 50 UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 3,000,00 X AGGREGATE $ 3,000,00 F EXCESS UAB CLAIMS -MADE CUP 2 813 295 07/01/2017 07/01/2018 DEDUCTIBLE $ $ RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVEY/N OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) NIA 4104361 05/01/2017 05/01/2018 WC STATu- OTH- TORY LIMITS X ER E.L. EACH ACCIDENT $ 1,000,00 E.L DISEASE - EA EMPLOYEE $ 1,000,00 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,00 C (Contractors Equip CLP 3 656 095 07/01/2017 07/01/2018 Inst Floa 353,00 � Leas/Rent 100,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) City of Fort Collins is named as additional insured with respects to General Liability policy. Project: Fort Collins -Loveland Municipal Airport Snow Removal Equipment (SW Building l.tK I II'II.H I t 1'1VLUtK (.HIV I.CLLH I IVIY CITYOFF SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS. 215 N Mason Fort Collins, CO 80522 AUTHORIZED REPRESENTATIVE © 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD