Loading...
HomeMy WebLinkAbout386996 WESTERN STATES RECLAMATION INC - INSURANCE CERTIFICATE (5)Client#: 33774 WESSTAPC ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 1 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 CO NAME: Analisa Murphy PHONE 720-622-8245 FAX 855-688-0075 E n Lo Exe : A/c, No 7600 East Orchard Road, Suite 330 South Greenwood Village, CO 80111 ADDRESS: amurphy@holmesmurphy.com INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: Travelers Property Casualty Co. 25674 INSURED Western States Reclamation, Inc. INSURERB: Pinnacol Assurance Company 41190 INSURER C : Zurich American Insurance Co. 16535 3756 Imperial Street INSURER D : Travelers Indemnity TlCo of Ameri 25666 Frederick, CO 80516 INSURER EAdmiral Insurance 124856 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. INSR LTR TYPE OF INSURANCE ADDL,SUBR INSR IWVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD LIMITS A X COMMERCIAL GENERAL LIABILITY X DTC0326DO29ATIL17 7/01/2017 07/01/2018 EACH OCCURRENCE $1,000 000 CLAIMS -MADE � OCCUR PREMISESOEaoccurrrence 000,000 X MED EXP (Any one person) $5,000 PD Ded: $2,500 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY [ JECOT ❑ LOC P GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP/OP AGG $2,000,000 $ OTHER: A AUTOMOBILE LIABILITY DT810326DO29ATIL17 7/01/2017 07/01/201 COMBINEDSINGLELIMIT Ea accident 1,000,000 BODILY INJURY (Per person) $ X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ X PROPERTY DAMAGE Per accident $ NON -OWNED HIRED AUTOS E AUTOS A X UMBRELLA LIAB X OCCUR CUP6J21666626TIL17 7/01/2017 07/0112018 EACH OCCURRENCE s5,000,000 AGGREGATE $5 000 000 EXCESS LIAB CLAIMS -MADE DED X RETENTION$1O 000 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVEY/N OFFICER/MEMBER EXCLUDED? FW (Mandatory In NH) N / A 4202787 WC039347700 7/01/2017 7/01/2017 07/01/201 07/01/201 X PER OTH- E.L. EACH ACCIDENT $1 000000 E.L. DISEASE - EA EMPLOYEE $1 ,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1 $1,000,000 D Leased/Rented Eq. __r� QT6602A931946TIA17 7/01/2017 07/01/201 $500,000; $2,500 Ded E Pollution & FEIECC1629704 7/01/2017 07/01/201 $2,000,000; $10,000 Ded Professional Liab DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Project Description: Landscaping Project at Horsetooth and Timberline. The Certificate Holder is an Additional Insured on the General Liability, including Completed Operations, and Business Automobile Liability, as required by written contract, per policy terms and conditions. GtK I IFIGA I t HULUtK City of Fort Collins SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO Box 580 ACCORDANCE WITH THE POLICY PROVISIONS. Fort Collins, CO 80522 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) 1 Of 1 The ACORD name and logo are registered marks of ACORD #S2925331M292373 MANV1