No preview available
HomeMy WebLinkAbout150588 WALSH CONSTRUCTION INC - INSURANCE CERTIFICATE (33)OP ID: RG 14 R" CERTIFICATE OF LIABILITY INSURANCE TE D 07/02/20YYYY) F 07/02/18 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 Phone: 970-223-1804 ACT NAME: Front Range Insurance Group 2002 Caribou Drive, Ste. 101 Fax: Fort Collins, CO 80525 David A. Wooldridge LUTCFAAI PHONE FAX a/C No Ext : A C, No): E-MAIL PRODUCER CUSTOMER ID #: WALSH-4 INSURER(S) AFFORDING COVERAGE NAIC # INSURED Walsh Construction, Inc. INSURER A:Pinnacol Assurance 41190 Matthew Walsh, Pres. 8139 Open View Place Loveland, CO 80537 INSURER B: Bitco General Insurance Corp INSURER C: Hamilton Special Insurance INSURER D : RSUI Indemnity Company INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 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 TYPE OF INSURANCE A DL U POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS B C B GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE LKOCCUR X Pollution Liab X CLP 3 670 670 AHSECC12316-00 CLP 3 670 670 07/01/2018 09/22/2017 07/01/2018 07/01/2019 09/22/2018 07/01/2019 EACH OCCURRENCE $ 1,000,00 DAMAGE T O RENTED PREMISES Ea occurrence $ 300,00 MED EXP (Any one person) $ 10,00 PERSONAL & ADV INJURY $ 1,000,00 X RailRoad Liab GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PRO LOC PRODUCTS - COMP/OP AGG $ 2,000,00 Poll Liab $ 1,000,00 B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS CAP 3 670 671 CAP 3 670 671 CAP 3 670 671 CAP 3 670 671 07/01/2018 07/01/2018 07/01/2018 07/01/2018 07/01/2019 07/01/2019 07/01/2019 07/01/2019 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,00 X BODILY INJURY (Per person) $ X BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ X X Comp Deduct $ 50 Coll Deduct $ 50 B X UMBRELLA LIAB EXCESS LIAR X OCCUR CLAIMS -MADE CUP 2 814 437 07/01/2018 07/01/2019 EACH OCCURRENCE $ 3,000,00 AGGREGATE $ 3,000,00 --- $ $ DEDUCTIBLE RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A 4104361 05/01/2018 05/01/2019 WC STATU- X OTH- T RY IMIT FP E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYEE $ 1,000,00 E L DISEASE - POLICY LIMIT _ $ 1,000,00 C Contractors Equip CLP 3 670 670 07/01/2018 07/01/2019 (Leas/Rent Inst Floa 353,00 250,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) City of Ft. Collins is listed as an Additional Insured with regards to the General Liability policy on ongoing and completed projects CERTIFICATE HOLDER CANCELLATION CITYOFF City of Fort Collins Attn: Purchasing P.O. Box 580 Fort Collins, CO 80522 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 © 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD