HomeMy WebLinkAbout109420 HYDRO CONSTRUCTION CO INC - INSURANCE CERTIFICATE (217)o® CERTIFICATE OF LIABILITY INSURANCE
DATE(MMIDDIYYYY)
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
AICNI. Ext: (970) 266-7149 FAX No: (970) 506-6845
E-MAIL DStewart@floodpeterson.com
ADDRESS:
PO Box 578
INSURER($) AFFORDING COVERAGE
NAIC #
INSURERA: Phoenix Insurance Company
25623
Greeley CO 80632
INSURED
INSURERS: 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
rnvcanc=c CFRTIFICOTF NtIMRFR• GL/AU,XS.IWC 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAYBE 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
INSD
SUER
WVD
POLICY NUMBER
POLICY EFF
MMIDD1YYYY
POLICY EXP
MMIDDIYYYY
LIMITS
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1.000,000
CLAIMS -MADE ®OCCUR
PREIAGE MISES Ea occTO a ante
S 300,000
MED EXP (Any one person)
$ 10,000
A
DT-CO-8G990899-PHX-18
04/01/2018
04/01/2019
PERSONAL&ADV INJURY
S 1,000,000
GEN'LAGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS
S 2,000,000
POLICY �X PE� LOC
S
OTHER.
AUTOMOBILE LIABILITY
COMBINED SINGLE 111,11T
(Ea accident)
$ 1,000,000
BODILY INJURY (Per person)
S
ANY AUTO
BODILY INJURY (Per accident)
$
B
OWNED SCHEDULED
AUTOS ONLY AUTOS
HIRED NON -OWNED
AUTOS ONLY X AUTOS ONLY
DT-810-8G990899-IND-18
04/01/2018
04/01/2019
PROPERTY DAMAGE
Per accitlentl
$
S
UMBRELLA LIAB
X
OCCUR
EACH OCCURRENCE
5 5,000,000
C
EXCESS LIAB
CLAIMS-h•IADE
CUP-2J40080A-18-26
04/01/2018
04/01/2019
AGGREGATE
S 5.000,000
DED I X1 RETENTION $ 10,000
$
D
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY v ! N
ANY PROPRIETOPUPARTNERIEXECUTIVE
OFFICER?MEMBER EXCLUDED?
(Mandatory In NH)
NIA
2091550
04/01/2018
04/01/2019
X PER OTH-
/� STATUTE ER
E.L. EACH ACCIDENT
1000,000
$ ,
E.L. DISEASE - EA EMPLOYEE
S 1,000,000
E.L. DISEASE - POLICY LIMIT
5 1,000,000
Ifyes, describe under
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS I LOCATIONS! VEHICLES (ACORD 101. Additional Remarks Schedule, may be attached If more space Is required)
re: #17-01-465
Project # SCP-WTF-HTDB-080517
WTF Replacement Project — High Priority Horsetooth Dissipator Electrical
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.
CERTIFICATE
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
� � C
Fort Collins CO 80521 ' (I
U 1988-2015 ACORD CORPOKAI IL)N. All rlgnts reservea.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD