HomeMy WebLinkAbout592927 HASELDEN CONSTRUCTION LLC - INSURANCE CERTIFICATE (10)P52601l2110112
QO DATE (MM/DD/YYYY)i
" AC_ORV CERTIFICATE OF LIABILITY INSURANCE 06/26/2018
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:
IMA, Inc. - Colorado Division PHONE — FAX
UVC. Ng. Ext1: A/C No): _.
E-MAIL d—CC@'—00XV'CCIm
1705 17th Street ADDRESS:
Suite 100 INSURER(S)AFFORDINGCOVERAGE NAILS
Denver, CO 80202 INSURER A: VALLEY FORDS INS CO (CHA) 20508
INSURED _ INSURERB: CONTINEWrAL INS CO (CHA) 35289
Haselden Construction, LLC INSURER CPIMACOL ASSDR 41190
6950 South Potomac Street INSURERD:
INSURER E :
Centennial, CO 80112 INSURERF:
rnvcoer_ee !`GOTICV`ATC uuunvta• 53TR2326 RFVI_glnN 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 ADDLTYPE OF INSURANCE INSD SUER POLICY
NUMBER MPWDICY EFF PW C
LTR DYIYYYY LOUTS
A
X
COMMERCIAL GENERAL LIABILITY
X
4028808411
07/01/18
07/01/19
EACH OCCURRENCE
$ 1,000,000
CLAIMS-MADE 1XI OCCUR
--
$ 1,000,000
DAMAGE TORENTEU—
PREMISES Ea occurrence
X
MED EXP (Any one person)
$ 15,000
PD Ded: $10, 000
PERSONAL & ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2,000,000
GEN'L
AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
$ 2,000,000
POLICY PRO-
JECT IX1 LOC
.
$
OTHER:
A
AUTOMOBILE LIABILITY
X
C4028808425
07/01/18
07/01/19
COMBINED SING LE LIMIT Ea accident
$ 1,000,000
BODILY INJURY (Per person)
ANY AUTO
$
OWNED SCHEDULED
AUTOS ONLY AUTOS
HIRED X NON -OWNED
AUTOS ONLY AUTOS ONLY
Ix
BODILY INJURY (Per socldent)
$
PROPERTY DAMAGE
Pef aa:ident
--
$
--
$
H
Y
UMBRELLALUIB
X
OCCUR
6042783626
07/01/18
07/01/19
EACH OCCURRENCE
$ 2,000,000
AGGREGATE
EXCESS LIAR
CLAIMS -MADE
$ 2,000,000
DED X RETENTIONS 10,000
$
C
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANYPROPRIETOR/PARTNERIEXECUTIVE a
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH)
NIA
4082635 - CO ONLY
07/01/18
07/01/19
X STATUTE I I R
_
$ 1,000,000
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
If yes, describe under
DESCRIPTION OF OPERA [IONS below
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required)
The City, its officers, agents and employees are included as Additional Insureds on the General and Automobile Liabilit
Policies if required by written contract or agreement and with respect to work performed by Insured subject to the
policy terms and conditions.
CERTIFICATE HULUEK %.AN1LrLLAIIUN
RE: CFC RFP 8546 - CM/GC On -Call.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
The City of Fort Collins THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
Attn: Purchasing Department
PO BOY 580 AUTHORIZED REPRESENTATIVE
Fort Collins, CO 80522 /Z&
USA
U 19BB-2015 ACUKU CUKVUKA I IUN. All rlgnts reserves.
ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
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53182326
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