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Home My WebLink About592927 HASELDEN CONSTRUCTION LLC - INSURANCE CERTIFICATE (14)P5260028002 ACC)Ra CERTIFICATE OF LIABILITY INSURANCE 06/26/sole ' 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: PHONE FAX A/C No): INA, Inc. - Colorado Division E-MAIL denaCC011nttechs@imac0 cOm ADDRESS: rp• 1705 17th Street INSURERS AFFORDING COVERAGE NAIC M Suite 100 INSURER A: VALLEY FORGE INS CO (CNA) 20508 Denver, CO 80202 _ INSURED INSURERS: CONTINENTAL INS CO (CNA) 35289 INSURER CPINNACOL ASSUR 41190 Haselden Construction, LLC INSURER D: 6950 South Potomac Street _ INSURER E : INSURER F: Centennial, CO 80112 ^A\/r:n Af!CQ PCDTICIPATC KIIIMMCD.-;11R1243 RFVICIr7N 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 LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER M IC YYYY MM/DD/YY P LIMITS A X COMMERCIALGENERALLIABILITY 4028808411 07/01/18 07/01/19 EACH OCCURRENCE _ $ 1,000,000 CLAIMS -MADE 1�1 OCCUR PREMISES Ea occurrence) $ 1, 000, 000 X MED EXP (Anyone person) $ 15,000 PD Ded: $10, 000 PERSONAL & ADV INJURY $ 1,000,000 GENI AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMPIOP AGG $ 2,000,000 POLICY � JECT a LOC $ OTHER: A AUTOMOBILE LIABILITY C4028808425 07/O1/18 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----- PeOaccident)DAMAGE $ B X UMBRELLA LIAB X OCCUR 6042783626 07/01/18 07/01/19 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 EXCESS LIAR CLAIMS -MADE DED I X RETENTION$ 10,000 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? (Mandatory in NH) NIA 4082635 - CO ONLY 07/01/18 07/01/19 X TI 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 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Fort Collins is included as Additional Insured 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. A Waiver of Subrogation is provided in favor of Additional Insured on the General, Automobile, Umbrella Liability and Workers Compensation Policies if required by written contract or agreement and with respect to work performed by Insured subject to the policy terms and conditions. UhKIIFIGAII_ MULUE11 IIVIY 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. PO BOX 580 AUTHORIZED REPRESENTATIVE Fort Colli/ I USA L ns, CO 80522 /'w � - V 19titl-1U15 AGUKU GUKYUKA I lUn. All rignis reserve0. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD emarrick 53183243