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HomeMy WebLinkAbout592927 HASELDEN CONSTRUCTION LLC - INSURANCE CERTIFICATE (16)P32N11U2011112 CERTIFICATE OF LIABILITY INSURANCE NYYY 1a/13/22017 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 1-303-534-4567 CONTACT NAME: 1MA, Inc. - Colorado Division PHONC FAX LAIC. N4, Exll: ---— IA/C. No,. E-MAIL denaccounttechagmacorp.coin 1705 17Ch Street ADDRESS:.i _ _ Suite 100 _ _ INSURER(S)AFFORDING COVERAGE NAICY___ Denver, CO 80202 INSURER A: VALLEY FORDS INS CO (CNA) 20508 _ INSURED INSURERS: CONTINENTAL INS CO(CNA Insurance) 35289 _ Haselden Construction, LLC INSURER CPIMUML ASHUR 41190 6950 South Potomac Street INSURER0: INSURER E : Centennial, CO 80112 1 INSURERF: COVERAGES CERTIFICATE NUMRFR- 51524021 REVISION NUMRFR- 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 TYPE OF INSURANCE ADOL SUBR POLICY EFF POLICY EXP LIMBS LTIt POLICY NUMBER MMIDD MKMD A Y I COMMERCIAL GENERALL1A81LITY C4028808411 07/01/17 07/01/18 EACH OCCURRENCE $ 1,000,000 --I CLAIMS -MADE I E OCCUR DAMA E TO RENTED PREMISES Ea occurrence $ 1,000,000 Y MED EXP (Any one person) $ 15,000 PD Ded: $10, 000 PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: JECT I _� LOC POLICY LYJ PRODUCTS - comp/op AGG $ 2,000,000 $ OTHER. A AUTOMOBILE LIABILITY _ IC4028808425 07/01/17 07/01/18 COMBINED SINGLE LIMIT Ea accident) _ S 1,000,000 BODILY INJURY (Per person) i X_ ANY AUTO I ALL OWNED SCHEDULED AUtOS AUTOS - $ BODILY INJURY (Pet accident) : Y X NON OWNED _ HIREDAUTOS AUTOS PROPERTY DAMAGE Peraccidenl f B X UMBRELLALIAS Y I OCCUR 6042783626 07/01/17 07/01/18 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 EXCESS LIAO _ _ CLAIMS -MADE $ DED Y RETENTIONS 10,000 C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE -1 OFFICERIMEMBER EXCLUDED? (Mandatory In NH) NIA 4082635 - CO ONLY 07/01/17 07/01/18 Y PERTATUT OER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, descnbe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT i 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached It more space is required) City of Fort Collins, its officers, agents, and employees are included as Additional insureds on the General, Automobil 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 Liability is excess of the General Liability, Automobile Liability and Rmployer•s Liability Policies. GtK11rIGAIr KULUtK I,AMIL tLLAI1VK RE: Work Order N PR-600110 City Hall ADA Upgrades. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Fort Collins THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TACCORDANCE WITH THE POLICY PROVISIONS. 300 LaPorte Ave Fort Collins, CO 80522 USA AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD ashacclain 51524021