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HomeMy WebLinkAbout129203 MARK YOUNG CONSTRUCTION - INSURANCE CERTIFICATEi , ® ACORL) CERTIFICATE OF LIABILITY INSURANCE �%. DATE (MM/DDIYYYY) 12/8/2016 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 endorsements . PRODUCER Commercial Risk Solutions 6600 E Hampden Ave Ste 200 Denver CO 80224 CONTACT NAME: Katie Smothers PHONE FAX E.t), 303-996-7801 tvc. IS,,;303-757-7719 E-MAIL ' . ksmothers@crsdenver.com INSURER 5 AFFORDING COVERAGE NAIC N INSURER A : CNA 20478 INSURED MARKY-1 INSURER B :Valley Forge Insurance Co. 20508 Mark Young Construction, Inc. INSURERC:American Casualty Company 20427 7200 Miller Place Frederick CO 80504 INSURER D: Pinnacol Assurance 41190 INSURER E:Transportation Insurance Co. 20494 INSURER F : Columbia Casualty Company 31127 COVERAGES CERTIFICATE NUMBER: 223478272 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 INSD WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS B F X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE .� OCCUR Y 50950531C4 C6016403435 12/31/2016 12/31/2016 12/31/2017 12/31/2017 EACH OCCURRENCE $1,000,000 DAMAGE ( RENTED PREMISESS Ea occurrence) $300,000 X MED EXP (Any one person) $5,000 Pollution/Prof X PD Ded: $2 000 PERSONAL &ADV INJURY $1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2.000,000 RPOLICY � IRE � LOC PRODUCTS - COMPIOP AGG _ $2,000,000 Pollution $2,000,000 X OTHER Poll SIR:$25,000 AUTOMOBILE LIABILITY Y 5084045242 12/31/2016 12/31/2017 MBINEtIN L LIMIT Eaacden $ 1,000,0A 0 X BODILY INJURY (Per person) $ ANY AUTO AUTOOWNED AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS X NON -OWNED AUTOS X PROPERTY DAMAGE Per accident $ C X UMBRELLA LIAB X OCCUR Y 5084045208 12/31/2016 12/31/2017 EACH OCCURRENCE $10,000,000 AGGREGATE $10,000,000 EXCESS LIAB CLAIMS -MADE DED I X RETENTION$10,000 $ D WORKERS COMPENSATION E AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? Y N / A 4016391 WC5093301998 1/1/2017 1/1/2017 1/1/2018 1/1/2018 PER ERN- X STATUTE ER E L. EACH ACCIDENT $1,000,000 E.L. DISEASE -EA EMPLOYEE $1,000,000 (Mandatory in NH) If yes, describe under DESGRiPTiOiJ OF OPERATIONS below E.L. DISEASE - POLiC'( L;f61T $1,000,000 A I Builders Risk 6045680802 12/31/2016 12/31I2017 Jobsite 12,000,000 Special Form/Theft Frame 5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE:City of Fort Collins and 8181 General Contractor for Southeast Community Park is included as additional insured for ongoing and completed operations on the General Liability and included as additional insured on the Auto Liability with respect to operations of the named insured for the certificate holder as required by written contract. Umbrella Liabilty follows form to the General Liability and Auto Liability with respect to the additional insured. all policy tems conditions and exclsuions apply. CERTIFICATE HOLDER CANCELLATION City of Fort Collins Purchasing Division 215 N. Mason St. 2nd Floor 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 © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD