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HomeMy WebLinkAbout592927 HASELDEN CONSTRUCTION LLC - INSURANCE CERTIFICATE (13)P5260028W2 DATE(MMIDD/YYYY) ACCWO 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 AIC No): E-MAIL denaccounttechs@imacorp.com 1705 17th Street ADDRESS: r'P• Suite 100 INSURERS AFFORDING COVERAGE NAIC S Denver, CO 80202 t1N­_RERB: SURERA:VALLEY FORGE INS CO (CNA) 20508 INSURED CONTINENTAL INS CO (CNA) 35289 Haselden Construction, LLCsuaeRc:PINNACOL ASSUR 41190 6950 South Potomac Street (Centennial, CO 80112 INSURER F: rnviceArcc rFRTiPirATP 1JIIUR1:0- 53183241 RFVISIAN NIJURFR- 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. ------- ---------------- ADDLSUBR--------------- —_-- POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MMIDDIYYYY MMIDDN A X COMMERCIAL GENERAL LIABILITY 4028808411 07/01/18 07/01/19 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE [11 OCCUR DAMAGETO PREMISES Ea occurrence) $ 1,000,000 X MED EXP (Any one person) $ 15,000 PD Ded: $10, 000 PERSONAL & ADV INJURY $ 1,000,000 GENLAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY [�] ECO- � LOC PRODUCTS - COMP/OPAGG $ 2,000,000 $ OTHER: A AUTOMOBILE LIABILITY C4028808425 07/01/18 07/01/19 COMBINEDSINGLELIMIT Ea accident $ 1000,000 , _ BODILY INJURY (Per person) _ $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS IX X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ $ H 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 DIED I X I RETENTION$ 10,000 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE OFFI CER/MEMBER EXCLUDI (Mandatary in NH) NIA 4082635 - CO ONLY 07/01/18 07/01/19 PER X STATUTE OE TRH_ — — E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT E 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below I I DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) City of Fort Collins, its officers, agents and employees are included as Additional Insureds on the General, Automobile 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 Policy is excess of the General Liability, Automobile Liability, and Employers Liability Policies. GtKIIMUAIt HULUtK I.AnVCLLAIIUN RE: Work Order # OP-483743 Lincoln Center Dewatering. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Fort Collins THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 300 LaPorte Ave Fort Collins, CO 80522 USA AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD emarrick 53183241