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Home My WebLink About592927 HASELDEN CONSTRUCTION LLC - INSURANCE CERTIFICATE (9)p�_axtxii? � r� DATE (MMIDDNYYY) CERTIFICATE OF LIABILITY INSURANCE 05/09/2018 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(iss) 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: IMA, Inc. - Colorado Division PHONE FAX IA&L No-iiq� IAIC. No): E-MAIL deIIBCCOUntteCbaQiMACOrp.CDm 1705 17th Street ADDRESS: Suite 100 INSURERS AFFORDING COVERAGE NAIC / Denver, CO 80202 INSURERA: VALLEY FORGE INS CO (CMA) 20508 INSURED INSURER6: CONTINENTAL INS CO(CMA Insurance) 35289 Baselden Construction, LLC INSURERC: PIMI'r^L ASSUR 41190 6950 South Potomac Street INSURER D: INSURER E : Centennial, CO 80112 1 INSURER F: rf%VFDAAFC rFDTIFIrATF NIIURFR- 528n1229 RFVISInN 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. INSR ADOL TYPE OF INSURANCE 1MAk SUER POLICY NUMBER MWPO ICY EXP LTR DCY EFF MMIDD LIMITS A X COMMERCIAL GENERAL LIABILITY C4028808411 07/01/17 07/01/18 EACH OCCURRENCE S 1,000,000 CLAIMS -MADE L] OCCUR GETO PREMISES Ea ocurrenc i 1,000,000 MED EXP (Any one person) $ 15,000 X PD Dad: $10, 000 PERSONAL 6 ADV INJURY $ 1,000,000 GENERAL AGGREGATE i 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: _ POLICY E JEOT � LOC PRODUCTS - COMP/OP AGG $ 2.000,000 $ OTHER. A AUTOMOBILE LIABILITY C4028808425 07/01/17 07/01/18 COMBINED SINGLE LIMIT Ea accident $ 1,000,000 _ BODILY INJURY (Per parson) $ _ X_ ANY AUTO BODILY INJURY (Per accident) $ ALL. OWNED SCHEDULED AUTOS AUNON-OWNED X HIRED AUTOS X AUTOS PROPERTY DAMAGE Per accklentlf $ B X UMBRELLA LIAB X OCCUR 6042783626 07/01/17 07/01/18 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 EXCESS UAB CLAIMS -MADE DED X RETENTION$ 10,000 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE FN OFFICERIMEMBER EXCLUDED? (Mandatory In NH) N / A 4082635 - CO ONLY 07/01/17 07/01/18 X I STATUTE ER - - E.L. EACH ACCIDENT f 1,000,000 E.L. DISEASE - EA EMPLOYE S 1,000,000 E.L. DISEASE - POLICY LIMIT = 1,000,000 H yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may he attached N more span Is required) City of Fort Collins is included as Additional Insured on the General, Automobile and Umbrella Liability Policies if required by written contract or agreement and with respect to work performed by Insured subject to the policy terms and conditions. A Waiver of Subrogation is provided in favor of Additional Insured on the General, Automobile, Umbrella Liability and Workers Compensation Policies if required by written contract or agreement and with respect to work performed by Insured subject to the policy terms and conditions. ,`CDTICIr`ArC Ur%l 111=0 rANrFI I ATTnW SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Fort Collins THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 580 AUTHORIZED REPRESENTATIVE Fort Collins, CO 80522/ Z/9 USA 1111 U 1988-ZU14 A(;UKL)GUKPUKA I IUN. All rlgnts reservea. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD sadie55 52801229 (n N u1 en z W