HomeMy WebLinkAbout479201 HEATH CONSTRUCTION - INSURANCE CERTIFICATE (11)P52W10211402
0
AC
�.-.� DATE (MM/DDIYYYY
A)
C CERTIFICATE OF LIABILITY INSURANCE 04/30/2018
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 1-303-534-4567 CONTACT
NAME:--
INA, Inc. - Colorado Division PHONE FAX
1705 17th Street AD6RESS: DenACCOuntTecheeimacorp.com
Suite 100 INSURERSIAFFORDING COVERAGE _ - NAIC6
Denver, CO 80202 INSURERA:HMTFORD FIRE IN CO 19682
INSURED INSURERB:TRUMBULL INS CO (Hartford Insurance CO) 27120
Heath Construction, LLC dba SaundersHeath INSURER CRNDDRANCE AVER INS CO 10641
141 Racquette Drive INSURERD: PINNACOL ASSOR 41190
P.O. Box Drawer H INSURERE:
Fort Collins, CO 80522 INSURERF:
/`AVCO A/SCO PCOTICIrATC MnuRCD. 1,2713919 RFVISIAN NIIIIII
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
LTRWVD
TYPE OF INSURANCE
ADL
SUER
POLICY NUMBER
MMIDDI EFF
POLICYMMI DI EXP
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE a OCCUR
$5, 000 PD Deductible
34UEAZT7859
04/30/18
04/30/19
EACH OCCURRENCE
$ 1,000,000
DAMAGE TO RENTED
PREMISES Ea occurrence)
$ 300,000
X
MED EXP(Any one person)
$ 10,000
PERSONAL & ADV INJURY
$ 1,000,000
GENI AGGREGATE LIMIT APPLIES PER:
POLICY a PRO-JECT n LOC
OTHER:
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS - COMP/OP AGG
$ 2,000,000
$
H
AUTOMOBILE LIABILITY
_
X ANY AUTO
OWNED (- SCHEDULED
AUTOS ONLY _ AUTOS
X HIRED NON -OWNED
AUTOS ONLY X AUTOS ONLY
34UEAZT7860
04/30/18
04/30/19
COMBINED SINGLE LIMIT
Ea accidenlL
S 1,000,000
_
BODILY INJURY (Per person)
S
BODILY INJURY (Per aocident)
$
PROPERTY DAMAGE
_jPer accident)
_
$
C
X
UMBRELLALIAB
EXCESS LUB
X
OCCUR
CLAIMS -MADE
XSC30000649200
04/30/18
04/30/19
EACH OCCURRENCE
y 10,000,000
AGGREGATE
$ 10, 000, 000
DIED RETENTIONS
$
D
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANYPROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBEREXCLUE
(Mandatory In NH)
If yes, descnbe under
DESCRIPTION OF OPLRAf IONS below
NIA
3096125 - Colorado
10/01/17
10/01/18
X STATUTE ERA
E-L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
El. DISEASE - POLICY LIMIT
f 1,000,000
DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if mom apace is required)
Ut:KIIMUAIt r1ULUtK l,Nl\I,CLLM11V17
RE: Contractor License.
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.
Attn: Delynn Coldiron
PO BOX 580 AUTHORIZED REPRESENTATIVE
Fort Collins, CO 80522-0580 USA //�&
(9)11958-2015 ACUKU GUKYUKA I IUN. All rlgnts reserveo.
ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
njones2014
52713918