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HomeMy WebLinkAboutAP MOUNTAIN STATES DBA ADOLFSON & PETERSON CONSTRU - INSURANCE CERTIFICATE (6)ACOIR "® CERTIFICATE OF LIABILITY INSURANCE page 1 of 1FDATE /(09/2017 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 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 NAME Willis of Minnesota, Inc. c/o 26 Century Blvd. P. 0. sox 305191 PHONE FAX • 877-945-7378 888-467-2378 E-MAIL certificatesQwillis.com Nashville, TN 37230-5191 INSURER(S)AFFORDINGcOVERAGE NAIC If INSURERA:Arch Insurance Company 11150-900 _ INSURED AP Mountain States, LLC INSURERB:Starr Indemnity and Liability Company 38318-001 INSURERC:Arch Insurance Company 11150-000 797 Ventura Street Aurora, CO 80011 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 25207260 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 ITR TYPE OF INSURANCE DDL SUB POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY y 51PKG8919403 3/1/2017 3/1/2018 EACH OCCURRENCE $ 2,000,000 CLAIMS -MADE OCCUR ppfplE iQAENTED PREMISES It aoccurence) $ 500 000 X MED EXP (Any one person) $ 10,000 Contractual Liability PERSONAL & ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 4,000,000 X PRO LOC JECT X F1POLICY PRODUCTS - COMP/OP AGG $ 4,000,000 $ OTHER: A AUTOMOBILE LIABILITY y 51PKG8919403 '3/1/2017 3/1/2018 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY(Per person) $ X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS $ BODILY INJURY(Per accident) PROPERTY DAMAGE (Peraccident) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY $ B UMBRELLALIAB X OCCUR y 1000023449 3/1/2017 3/l/2018 EACH OCCURRENCE $ 11000,000 X AGGREGATE $ 1,000,000 EXCESS LIAB CLAIMS-MADE DED RETENTION $ $ C WORKERS COMPENSATION AOS 51WC28919303 3/1/2017 3/1/2018 X AND EMPLOYERS' LIABILITY ANY PROPR!ETORIPA.RTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? 4Mandatory in NH) f yes, describe under DESCRIPTIONOFOPERATIONSbelow NSA E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 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) Re: Courthouse Security Upgrade Project #7310. City of Fort Collins, CO is included as an Additional Insured as respects to General Liability, Auto Liability and Umbrella/Excess Liability, when required by written contract, agreement or permit executed prior to loss. CERTIFICATE HOLDER GAN ;ELLA I IUN 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 City of Fort Collins, CO 300 LaPorte Ave Fort Collins, CO 80522 Co11:5030589 Tn1:2124901 Cert:25�07260©1988-p015ACORD CORPORATION. All riahtsreserved ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD