HomeMy WebLinkAboutHASELDEN CONSTRUCTION LLC - INSURANCE CERTIFICATE (5)Pill+N1.141u2
AC40 07/2ATE CERTIFICATE OF LIABILITY INSURANCE IDDNYYY)
7/a7/201ao17
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:
LA, Inc. - Colorado Division PHONE FAX
wll _NQ. tom: UUC. Nol:
E-MAIL denaccounttechs�imacorp.com
1705 17th Street ADDRESS:
Suite 100 INSURER(S) AFFORDING COVERAGE NAIC 0
Denver, CO 80202 INSURER A: VALLEY FORGE INS CO (CIA) 20508
INSURED - INSURERS: CONTINENTAL INS CO(C!A Insurance) 35289
Haaelden Construction, LLC INSURERC: PIMOML ASSUR 41190
6950 South Potomac Street INSURER O: __
INSURER E :
Centennial, CO 80112 1 INSURERF:
rnvcoAr_cc rCOTICIrATC a111aaRCD• Sndd6221 RFVIS1r1N 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.
NSR
LTR
TYPE OF INSURANCE
ADOL
��
POLICY NUMBER
MMIDDYIYYYY
MMIDDY EXP
LIMITS
A
%
COMMERCIAL GENERAL LIABILITY
%
C4028808411
07/01/17
07/01/18
EACH OCCURRENCE
$ 1,000,000
CLAIMS -MADE l X 1 OCCUR
DAMAGE TO RENTED
PREMISES (Ea occurrencel
S 1,000,000
%
MED EXP (Any one person)
$ 15,000
PD Ded: $10, 000
PERSONAL 4 ADV INJURY
i 1,000,000
GENT AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS - COMP/OP AGG
= 2,000,000
POLICY a PRO-
ECri-I LOC
OTHER:
A
AUTOMOBILE LABILITY
%
C4028808425
07/01/17
07/01/18
COMBINED SINGLE LIMIT
1Ea.accidentl
= 1,000,000
---
BODILY INJURY (Per person)
$
ANY AUTO
BODILY INJURY (Per accident)
$
ALL OWNED SCHEDULED
AUTOS AUTO S N-OWNEDPROPERTY
AUTOS % AUTOS
Ix
DAMAGEHIRED
Per accident
___.
$
B
X
UMBRELLA LIAS
%
OCCUR
6042783626
07/01/17
07/01/18
EACHOCCURRENCE
$ 2,000,000
AGGREGATE
$ 2.000, 000
EXCESS LAB
CLAIMS -MADE
_
DED % RETENTION=10,000
$
C
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETORIPARTNERIEXECUTIVE �
OFFICERIMEL48ER EXCLUDED?
(Mandatory In NH)
NIA
4082635 - CO ONLY
07/01/17
07/01/18
% STATU OR
E.L. EACH ACCIDENT
f 1,000,000
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
E.L. DISEASE - POLICY LIMIT
f 1, 000, 000
It yes, describe under
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Addklonal Remarks Schedule, may be attached If mom space Is required)
The City, its officers, agents and employees are included as Additional Insureds on the General and Automobile Liabilit
Policies if required by written contract or agreement and with respect to work performed by Insured subject to the
policy terms and conditions.
GtK I IFIGA I t KULUtK k.M Nt.,CLLA I I%JM
RE: CFC RFP 8546 - CN/GC On -Call.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
The City of Fort Collins THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
Attn: Purchasing Department
PO BOX 580 AUTHORIZED REPRESENTATIVE /�
Fort Collins, CO 80522 , Z&
USA 111
U 1975S-ZU14 AGUKU GUKYUKA I IUN. All rlgnT3 reserves
ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
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