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Home My WebLink About592927 HASELDEN CONSTRUCTION LLC - INSURANCE CERTIFICATE (12)P52600?9002 A� aR-I - CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD YYYY) 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 INA, Inc. - Colorado Division CONTACT NAME: PHONE IFAX 0,_No. Ertl' (A/C. No): E-MAIL denaccounttechs@imacorp.com ADDRESS: 1705 17th Street INSURERS AFFORDING COVERAGE NAIC # Suite 100 INSURER A: VALLEY FORGE INS CO (CNA) 20508 Denver, CO 80202 _ _ _ INSURED INSURERS: CONTINENTAL INS CO (CNA) 35289 INSURER CPINNACOL ASSUR Haselden Construction, LLC 41190 INSURER0: 6950 South Potomac Street INSURER E : 1 INSURERF: Centennial, CO 80112 1%AVCOA/1CQ f-COTICIr ATC NIIMRCR• 53183239 RFVISION NLIMKI-H[ 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 TYPE OF INSURANCE INS SUER POLICY NUMBER MMI DY EFF MOM/LDI D EXP LIMITS A X ICOMMERCIAL GENERAL LIABILITY 4028808411 07/01/18 07/01/19 EACHOCCURRENCE $ 1,000,000 CLAIMS -MADE IJ OCCUR PREMISES EeEoccurrence) $ 1,000,000 X MED EXP (Any one person) $ 15,000 PD Ded: $10, 000 PERSONAL & ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OPAGG $ 2,000,000 POLICY LJ PECTRO- a LOC J $ OTHER: A AUTOMOBILE LIABILITY C4028808425 07/01/18 07/01/19 COMBINED SINGLE LIMIT Ea accident) g 1,000,000 BODILY INJURY (Per person) $ X ANY AUTO BODILY INJURY (Per accident) $ OWNED SCHEDULED AUTOS ONLY AUTOS X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY P OPPER,d ^DAMAGE $ $ E X UMBRELLA LIAB X OCCUR 6042783626 07/01/18 07/01/19 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 EXCESS LIAB CLAIMS -MADE DEO I X I RETENTION $ 10, 000 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICE(Mandatory In N REXCLUDED? (Mandatory In NH) NIA A 4082635 - CO ONLY 07/01/18 07/01/19 IPER X STATUTE ERH E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below i DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if mom space Is required) City of Fort Collins, its officers, agents, and employees are included as Additional Insureds on the General, Automobil and Umbrella Liability Policies if required by written contract or agreement and with respect to work performed by Insured subject to the policy terms and conditions. The Umbrella Liability is excess of the General Liability, Automobile Liability and Employer's Liability Policies. RE: Work Order # PR-600110 City Hall ADA Upgrades. City of Fort Collins 300 LaPorte Ave Collins, CO 80522 USA I.HIgI,CLLH I IVN 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 V 19UU-ZU15 AGVKU GUKYVKAI IVN. All rlgnLs reserve0. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD emarrick 53183239 M W.