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HomeMy WebLinkAboutLEFT HAND EXCAVATING LLC - INSURANCE CERTIFICATE (3)LEFHANPC Client#: 33545 ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 12/27/2016 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 Holmes Murphy - Colorado 7600 East Orchard Road, Suite 330 South CONTACT Craig Merten PHONE 720-622-8242 Fox 855-534-8895 A/C No Ext : A/C, No): E-MAIL ADDRESS: cmerten@holmesmurphy.com Greenwood Village, CO 80111 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: QBE Insurance Corporation 39217 INSURED Left Hand Excavating, LLC INSURERB: Pinnacol Assurance Company 41190 INSURER C : Atlantic Specialty Insurance Co 27154 7733 N 73rd Street Longmont, CO 80503 INSURER D : 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 CONTRACTOR 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 INSR SUBR WVD POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY X CC11174022 11 /17/2016 01/01/2018 EACH OCCURRENCE $1,000,000 CLAIMS -MADE OCCUR PREMISESOEe ocicur ence $1 OO1 OOO X MED EXP (Any one person) $10 000 PD Ded: $1,000 Ltd. Pollution- PERSONAL &ADV INJURY $1,000,000 Worksites LAGGREGATELIMITAPPLIESPER: GENERAL AGGREGATE $2,000,000 $1,000,000 Limit POLICYa JECOTFX LOC r,OTHER: PRODUCTS-COMP/OPAGG $2,000,000 1 $ A AUTOMOBILE LIABILITY CBA1174020 11/17/2016 01/01/2018 COMBINED SINGLE LIMIT Ea accident$1,000,000 BODILY INJURY (Per person) $ X ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED X HIRED AUTOS X AUTOS PROPERTY DAMAGE Per accident $ A X UMBRELLA LIAB X OCCUR CCU1174021 1/17/2016 01/01/2018 EACH OCCURRENCE $1 OOO 000 AGGREGATE $1 OOO 000 EXCESS LIAB CLAIMS -MADE DED I X RETENTION $1O 000 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/ N OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N / A 1663960 1/01/2017 01/01/201 X PER OTH- E.L. EACH ACCIDENT $500OOO E.L. DISEASE - EA EMPLOYEE $500,000 E.L. DISEASE -POLICY LIMIT s500,000 If yes, describe under DESCRIPTION OF OPEP.AT!ONS below C Leased/Rented Eq. 7900067540008 11/17/2016 01/01/201 $250,000 Limit $1,000 Deductible DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Project Description: Right of Way Contractor's License The following are Additional Insureds as respects General Liability only to the extent coverage might apply according to the policy terms, conditions and exclusions. Consult the policy to determine extent of coverage. This Certificate confers no rights on the Certificate Holder. Additional Insureds: City of Fort Collins City of Fort Collins SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN P O Box 580 ACCORDANCE WITH THE POLICY PROVISIONS. Fort Collins, CO 80522-0580 AUTHORIZED REPRESENTATIVE THIZ7 © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) 1 of 1 The ACORD name and logo are registered marks of ACORD #S257818/M257793 MANV1