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Home My WebLink About127137 LA WOODWORKS INC - INSURANCE CERTIFICATE (5)AC R" CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNY-YY) 5/17/2018 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 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 CONTNAME Karole Karole Peters Ewing —Leavitt Insurance Agency, Inc. PHONE (970) 679-7355 FAX No: (866)237-2178 4090 Clydesdale Parkway atMDRILESS:karole—peters@leavitt.com Suite 101 INSURERS AFFORDING COVERAGE NAIC # Loveland CO 80538 INSURERAACUITY Group 14184 INSURED INSURER B :PinnaC01 LA Woodworks Inc. INSURER C : 4476 Bents Drive INSURERD: LWindsor CO 80550 1 INSURERF COVFRAGFS CFRTImr ATF NI IIUQP0.1 R-1 Q er�ncr�u . 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 LT I TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MMIDDNYYYI POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR Z46492 6/1/2018 6/l/2019 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $ 500,000 X MED EXP (Any one person) $ 10,000 Blkt Additional Insured X X Blkt Waiver of Subro PERSONAL & ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: a PRO - POLICY El LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: A AUTOMOBILE LIABILITY Z46492 6/1/2018 6/1/2019 Ee aBINEDccidenSINGLE LIMIT $ 1,000,000 X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS X BODILY INJURY (Per accident) $ HIRED AUTOS X NON -OWNED AUTOS X PROPERTY DAMAGE Per accident $ X $ Blkt At X Blkt WOS A X UMBRELLA LIAB X OCCUR Z46492 6/1/2018 6/1/2019 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5 000 000 EXCESS LIAB CLAIMS -MADE DED I X I RETENTION 0 $ X B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? NIA 4148953 Blanket Waiver of 6/1/2018 6/l/2019 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 (Mandatary in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Subrogation E.L. DISEASE - POLICY LIMIT I $ 500,000 A Installation Floater Z46492 6/l/2018 6/1/2019 Temporary Storage-$1,000 ded $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Block 32 UAB Const Phase. A&P Job # 7106. AP Mountain States LLC, City of Fort Collins, Colorado and others as required by contract are named additional insured on the General Liability and Auto Liability policies as regards work performed by the insured on this project. A waiver of subrogation applies in favor of the additional insureds listed above as regards the General Liability, Auto Liability and Workers' Compensation policies. VLI\1311 r\IL r1VLUGR 1LANLtLLAI IUN City of Fort Collins, Colorado PO Box 580 Fort Collins, CO 80522 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 Karole Peters/KAPETE MA<4 v 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INCfYJR ronlnni �