HomeMy WebLinkAbout109420 HYDRO CONSTRUCTION CO INC - INSURANCE CERTIFICATE (212)CERTIFICATE OF LIABILITY INSURANCE
DATE(MM/DDIYYYY)
03/29/2018
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
CONTACT Dana Stewart, CIC, CISR
NAME:
Flood and Peterson
IPFIA CNN.Ext : (970j 266-7149 A/c, No): (970) 506-6845
E-MAIL DStewart@floodpeterson.com
ADDRESS:
PO Box 578
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURER A: Phoenix Insurance Company
25623
Greeley CO 80632
INSURED
INSURER B : Travelers Indemnity Company
25658
INSURER C : Travelers Property Casualty Company of America
25674
Hydro Construction Company Inc.
INSURER D : Pinnacol Assurance
41190
77 NW Frontage Road
INSURER E :
INSURER F
Fort Collins CO 80524
COVERAGES CERTIFICATE NUMBER: GUAU/XS/WC x4/19 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.
INTRR
TYPE OF INSURANCE
INSD
WV
POLICY NUMBER
MMfDDYIYYYY
MM DD/Y YY
LIMITS
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1.000,000
CLAIMS -MADE ® OCCUR
AMAG ENT
PREMISES (Ea occurrence)
300.000
S
MED EXP (Any one person)
$ 10,000
PERSONAL&ADV INJURY
s 1,000,000
A
Y
DT-CO-8G990899-PHX-18
0410112018
04/01/2019
GEN'LAGGREGATE LIMIT APPLIES PER :
GENERAL AGGREGATE
y 2,000,000
PRODUCTS AGG
2,000,000
SPOLICY
PRO
JECT❑LOC
S
OTHER:
AUTOMOBILE LIABILITY
COP:181NED SINGLE UNITS
iEa accident
1,000,000
BODILY INJURY (Per personl
S
ANY AUTO
B
OWNED SCHEDULED
AUTOS ONLY AUTOS
HIRED NON -OWNED
AUTOS ONLY /� AUTOS ONLY
Y
DT-810-8G990899-IND-18
04101/2018
04/01/2019
BODILY INJURY (Per accident)
S
PROPERTY DAMAGE
(Per accident
S
5
X
UMBRELLALIAB
X
OCCUR
EACH OCCURRENCE
$ 5.000,000
C
EXCESS LIAR
CLAIMS -MADE
Y
CUP-2J40080A-18-26
04/01/2018
04/01/2019
AGGREGATE
S 5,000,000
DED I X1 RETENTION S 10,000
y
D
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETOR,PARTNER;EXECUTIVE
OFFICER. EXCLUDED?
(Mandatory In NH)
N/A
2091550
04/01/2018
04/0112019
X STATUTE EORH
E.L. EACH ACCIDENT
s 1 .000,000
E.L. DISEASE - EA EMPLOYEE
S 1,000,000
DISEASE -POLICY LIMIT
1,000,000
$
It yes, describe under
DESCRIPTION OF OPERATIONS belowE.L.
DESCRIPTION OF OPERATIONS! LOCATIONS / VEHICLES (ACORD 101. Additional Remarks Schedule, maybe attached If more space Is required)
Project #: 18-01-512
Owner' Project # H-WRF-2018-09
DWRF Digester Circulation Pumps Replacement
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.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS.
700 Wood Street
AUTHORIZED REPRESENTATIVE
Fort Collins CO 80521
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