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HomeMy WebLinkAbout201461 CONSTRUCTION CONCEPTS INC - INSURANCE CERTIFICATE (12)AC� ® 7�6/21/2018 TE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 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 endorsements . PRODUCER CONTACT Karole Peters NAME: Ewing -Leavitt Insurance Agency, Inc. PHONE (970) 679-7355 FAX (866)237-2178 C No : _ 4090 Clydesdale Parkway ADDRlESS:karole-peters@leavitt.com Suite 101 INSURERS AFFORDING COVERAGE NAIC # Loveland CO 80538 INSURERA:Cincinnati Insurance Co 10677 INSURED INSURER B :Pinnacol Assurance 41190 Construction Concepts Inc INsuRERC:Atlantic Specialty Insurance 27154 14125 Mead Street INSURER D : INSURER E I Longmont CO 80504 1 INSURER F : rnVFRAGFS CFRTIFICATF NIIMRFR•18-19 WC RFVIIRI(1N NI IMRFR• 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 I TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑X OCCUR Blkt Additional Insured X EPP0162368 10/1/2017 10/1/2018 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PR MISES Ea.c.".n $ 500,000 X MED EXP (Any one person) $ 10,000 X Blkt Waiver of Subro PERSONAL BADVINJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: POLICY X JE� LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS X NON -OWNED HIRED AUTOS AUTOS Blkt Al X Blkt WOS X EPP0162368 10/1/2017 10/1/2018 COMBINED SINGLE LIMIT a Ea ccident $ 1,000,000 X BODILY INJURY (Per person) $ BODILY INJURY Per accident ( ) $ X PeOa R tDAMAGE $ X $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE EPP0162368 10/l/2017 10/1/2018 EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 DED X I RETENTION 0 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA 4031745 7/1/2018 7/1/2019 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 C A Builders Risk - Reporting Leased/Rented Equipment 790-01-03-05-0006 10/1/2017 EPP0162368 10/1/2017 10/1/2018 10/1/2018 Any One Structure ($1,000 ded) $2 , 500 , 000 Limit with $1,000 ded $150,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Oak Street Restrooms. The City of Fort Collins is named as additional insured on the general liability and auto liability as regards work performed by the insured per written agreement. CERTIFICATE HOLDER CANCELLATION City of Fort Collins 214 North Mason Street 2nd Floor Fort Collins, CO 80524 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 role Peters/KAPETE 04<-M�" ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD l Klgn7S (-A-