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HomeMy WebLinkAboutASPEN CONSTRUCTION - INSURANCE CERTIFICATE (2)ACORN® 1111-� CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD YYYY) 5/23/2018 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 have ADDITIONAL INSURED provisions or 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 CUNIACI NAME: Paula Blohm Madison Insurance Group PHONE, Ext : 3033220800 (A/X, No): 3033220874 ADDRESS: pblohmCamadisoninsurance.net 600 South Cherry St, Ste 900 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : PINNACOL ASSURANCE 41190 Denver CO 80246 INSURED INSURER B : AUTO OWNERS INSURANCE INSURER C : SECURITY NATIONAL INSURANCE COMPANY Aspen Construction Enterprises, Inc dba Aspen Construction INSURER D : NATIONAL UNION FIRE INSURANCE COMPANY 204 N. Link Lane #3 INSURER E : INSURER F : Fort Collins CO 80524 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. LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS C X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Fx_] OCCUR NA154653500 04,29,2018 04/29/2019 EACH OCCURRENCE $ 1,000,000 PREMISES (Ea occurrence) $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL &ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: x POLICY jE O LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ B AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY x AUTOS ONLY 50-675-828-00 04/28/2018 04/28/2019 (Ea accident) $ 1,000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ X (Per accident) $ 5 D UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE QEXR4593816 04/29/2018 04/20/2019 EACH OCCURRENCE $ 1,000,000 X AGGREGATE $ 1,000,000 DED RETENTION $ $ A ORKERS COMPENSATION ND EMPLOYERS' LIABILITY NY PROPRIETOR/PARTNER/EXECUTIVE Y / N FFICER/MEMBEREXCLUDED? Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A 3018240 06/01/2018 06/01/2019 X F77TUTE EQIH- R E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE s 500,000 E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Fort Collins Utilities ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 580 AUTHORIZED REPRESENTATIVE Fort Collins, CO 80522 paµrc.13L&k, © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD