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Home My WebLink About127137 LA WOODWORKS INC - INSURANCE CERTIFICATE (6)ACC)R ® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 6._� 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 CONTACT NAMErole Peters Ewing -Leavitt Insurance Agency, Inc. PHONE (970)679-7355 FAX C No : (866) 237-2178 4090 Clydesdale Parkway aDORIESS:karole-peters@leavitt.com Suite 101 INSURERS AFFORDING COVERAGE NAIC # Loveland CO 80538 INSURERAACUITY Group 14184 INSURED INSURER B :Pinnacol Assurance 411 90 LA Woodworks Inc. NSURER C : 4476 Bents Drive [1�14SURERD: Windsor CO 80550 I INSURER F CC)VFQAr.FS CFDTIFIr ATF kll IIIAM=D•1 A-1 Q roc nc��u w u�nrn_ 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR Z46492 6/1/2018 6/1/2019 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 GEML AGGREGATE LIMIT APPLIES PER: POLICY FX] ECT LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: A AUTOMOBILE LIABILITY Z46492 6/1/2018 6/1/2019 COEa aMcciBINED SINGLE LIMIT dent $ 1,000,000 X BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS X BODILY INJURY (Per accident) $ HIRED AUTOS X NON -OWNED AUTOS X PROPERTY DAMAGE Per accident $ X $ Blkt Al X Blkt WOS A X UMBRELLA LIAB X OCCUR Z46492 6/1/2018 6/l/2019 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 EXCESS LIAB CLAIMS -MADE DED X I RETENTION 0 $ X B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? N / A 4148953 Blanket Waiver of 6/1/2018 6/1/2019 X STERATUTE ERH E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 (Mandatory in NH) If yes, describe under Subrogation E.L. DISEASE - POLICY LIMIT I $ 500,000 DESCRIPTION OF OPERATIONS below A I Installation Floater Z46492 6/1/2018 6/1/2019 Temporary Storage-$1,000ded $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Utilities Service Center. Project #: 7157. AP Mountain States LLC, City of Fort Collins 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. �.�rc r rn� ri i nva u�rc GANGtLLA 1 IUN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Fort Collins THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO Box 5580 ACCORDANCE WITH THE POLICY PROVISIONS. Fort Collins, CO 80522 AUTHORIZED REPRESENTATIVE Karole Peters/KAPETE U 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INC/19r /on9 AMA