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HomeMy WebLinkAbout109420 HYDRO CONSTRUCTION CO INC - INSURANCE CERTIFICATE (213)A� b' CERTIFICATE OF LIABILITY INSURANCE DATE(MM/03;29i2018 Y) 018 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 A CNNo Ext : (970) 266-7149 aC No): (970) 506-6845 E-MAIL ADDRESS: DStewart@floodpeterson.com PO Box 578 INSURER(S) AFFORDING COVERAGE NAIC # Greeley CO 80632 INSURER A: Phoenix Insurance Company 25623 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: GLIAU/XS/WC x4i19 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. TR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM DDY EFF MM1DD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1.000,000 CLAIMS -MADE ©OCCUR DAMAGE TO RNTE PREMISES EaEoecu ence $ 300,000 MED EXP (Any one person) 5 10,000 PERSONAL&ADV INJURY S 1,000,000 A DT-CO-8G990899-PHX-18 04/01/2018 04/01/2019 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS -COMPIOPAGG S 2.000,000 PRO- ❑ POLICY JECT LOG S OTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) S 1,000,000 BODILY INJURY (Per person) S ANY AUTO B OWNED SCHEDULED AUTOS ONLY AUTOS HIRED HNON-OWNED AUTOS ONLY AUTOS ONLY DT-810-8G990899-IND-18 04/01/2018 04/01/2019 BODILY INJURY (Pe accident) $ PROPERTY DAMAGE Per accident S UMBRELLALIAB X OCCUR EACH OCCURRENCE S 5.000,000 C EXCESS LIAB CLAIMS -MADE CUP-2J40080A-18-26 04/01/2018 04/01/2019 AGGREGATE S 5,000,000 DED I X1 RETENTION $ 10,000 S D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORPARTNERiEXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) N/A 2091550 04/01/2018 04/01/2019 X /� STATUTE ER E.L. EACH ACCIDENT $ 1,000.000 E.L. DISEASE - EA EMPLOYEE S 1.000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS t LOCATIONS! VEHICLES (ACORD 101. Additional Remarks Schedule, may be attached if more space Is required) Project # 17-01-447, Owners project number BPM-WTF-PPR-5-05-17 24" Poudre Pipeline Rehabilitation Assessment -Phase 1 Procurement. Certificate holder is included as Additional Insured as required by written contract with respects to liability arising out of work performed by the named insured. GANGtLLA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Fort Collins Utilities ACCORDANCE WITH THE POLICY PROVISIONS. 700 Wood Street AUTHORIZED REPRESENTATIVE Fort Collins CO 80521 y J © 1988-2015 ACORD CORPORATION. All rights reserves. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD