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HomeMy WebLinkAboutHALCYON CONSTRUCTION INC - INSURANCE CERTIFICATE (3)A� " CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 11/28/2017 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 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 Flood and Peterson PO Box 578 Greeley CO 80632 CONTACT NAME: Jennifer Winter CISR PHONE (970)506-3206 FAXNo:(970)506-6846 ADDRESS:JWinter@floodpeterson.com INSURERS AFFORDING COVERAGE NAIC # INSURER A:Trans ortation Insurance Company 20494 INSURED Halcyon Construction, Inc. 4627 W. 20th Street, Suite B Greeley CO 80634 INSURERB:Continental Casualty Company 20443 INSURERC:The Continental Insurance Company 35289 INSURERD:Pinnacol Assurance 41190 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER:CL17112820670 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. INSR LTR ADDLSUTYPE OF INSURANCE B POLICY NUMBER MWDD/YLICY EYYY MFF WDD/YLICY YYY LIMITS A • COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑X OCCUR BI/PD Ded: 10 , 000 6023707293 12/5/2017 12/5/2018 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES(E. occurrence $ 500,000 X MED EXP (Any one person) $ 15,000 PERSONAL & ADV INJURY $ 1,000,000 _ GENT AGGREGATE LIMIT APPLIES PER: ^I POLICY JE O- LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ B AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED X HIRED AUTOS X AUTOS X Drive Other Car 6023707262 12/5/2017 I 12/5/2018 COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ $ C X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE 6023707276 12/5/2017 ;12/5/2018 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 DED X RETENTION$ 10,000 $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETCRIPARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A 4160879 1/1/2018 1/1/2019 X STATUTE ERA E.L. EACH ACCIDENT $ 1,000,000 - - --_-- E.L. DISEASE - EA EMPLOYE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) R City of Fort Collins 300 LaPorte Avenue Fort Collins, CO 80521 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE J Winter, CISR/JWINTE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD