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HomeMy WebLinkAbout592927 HASELDEN CONSTRUCTION LLC - INSURANCE CERTIFICATE (17)P52(�M)2a1M12 ACC Cam a/13/2017 CERTIFICATE OF LIABILITY INSURANCE DATE3/2 I l kb�_ F 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:__ IMA, Inc. - Colorado Division PHONE FAX WC.Nn,IEXU_---"--- ------ IAIL 1705 17th Street IELD_DRESS:_ denaccounttechs@imacorp.com Suite 100 INSUREPAS) AFFORDING COVERAGE NAIC0 Denver, CO 80202 INSURERA: VALLEY FORGE INS CO (CUR) 20508 INSURED INSURERS: CONTINENTAL INS CO(CNA Insurance) 35289 Haselden Construction, LLC INSURER CPIMUML ASSUR 41190 330 S. College Ave, Suite 300 INSURERD: INSURER E : _ FOrt Collins, CO 80524 1 INSURER F: COVERAGES CERTIFICATE NUMBER: 51523877 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 ---- TYPE OF INSURANCE --- - - - - _-ADOL SUBR -- - _-_-- -- POLK:Y NUMBER - MMIDDYIYVYY MMIDDY EI(P - LIMITS LTR A X COMMERCIAL GENERAL LIABILITY C4028808411 07/01/17 07/01/18 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE 1. XX I OCCUR 1AGE S ( DENTED PREMISES Ea occurtence S 1,000,000 X MED EXP (Any one person) r: 15,000 PD Ded: $10, 000 PERSONAL&ADV INJURY 1 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: IX J ET . PRODUCTS f 2,000,000POLICYC f OTHER-. A AUTOMOBILE LIABILITY _ C4028808425 i07/01/17 07/01/18 COMBINED SINGLE LIMIT Ea accident S 1,000,000 BODILY INJURY (Per person) X ANY AUTO $ ALL OWNED SCHEDULED AUTOS J AUTOS BODILY INJURY (Per accident) - i PROPERTY DAMAGE Per accident) X „ NON -OWNED HIRED AUTOS ^ JI AU10S $ — S B X UMBRELLA X OCCUR 6042783626 07/Ol/17 07/Ol/18 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 EXCESS LIAR_ CLAIMS -MADE DED I X RETENTIONS 10,000 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETOR/PARTNERIEXECUTIVE -1 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) NIA 4082635 - CO ONLY 07/01/17 07/01/18 X STATU OR E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEO f 1,000,000 If yes, describe under DESCRIPTION OF OPERAI IONS below E.L. DISEASE - POLICY LIMIT $ 1, 000, 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more apace 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 Employer's Liability Policies. L:tK I IYIL;A 1 t MULUtK L,ANL.tLLA I IUN RE: work Order # 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 ACCORDANCE 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 fkm5013 51523877 M O N V W P526W284X)2 CNA75079XX 0115 Page 1 of 2 Haselden Construction, LLC #C4028808411 7/ 1 / 17-7/ l / 18 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART It is understood and agreed as follows: 1. The WHO IS AN INSURED section is amended to add as an Insured any person or organization whom the Named Insured is required by written contract to add as an additional insured on this coverage part, including any such person or organization, if any, specifically set forth on the Schedule attachment to this endorsement. However, such person or organization is an Insured only with respect to such person or organization's liability for: A. unless paragraph B. below applies, 1. bodily injury, property damage, or personal and advertising injury caused in whole or in part by the acts or omissions by or on behalf of the Named Insured and in the performance of such Named Insured's ongoing operations as specified in such written contract; or 2. bodily injury or property damage caused in whole or in part by your work and included in the products -completed operations hazard, and only if a. the written contract requires the Named Insured to provide the additional insured such coverage; and b. this coverage part provides such coverage. B. bodily injury, property damage, or personal and advertising injury arising out of your work described in such written contract, but only if: 1. this coverage part provides coverage for bodily injury or property damage included within the products completed operations hazard; and 2. the written contract specifically requires the Named Insured to provide additional insured coverage under the 11-85 or 10-01 edition of CG2010 or the 10-01 edition of CG2037. II. Subject always to the terms and conditions of this policy, including the limits of insurance, the Insurer will not provide such additional insured with: A. coverage broader than required by the written contract; or B. a higher limit of insurance than required by the written contract. III. The insurance granted by this endorsement to the additional insured does not apply to bodily injury, property damage, or personal and advertising injury arising out of: A. the rendering of, or the failure to render, any professional architectural, engineering, or surveying services, including: 1. the preparing, approving, or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; and 2. supervisory, inspection, architectural or engineering activities; or B. any premises or work for which the additional insured is specifically listed as an additional insured on another endorsement attached to this coverage part. IV. Notwithstanding anything to the contrary in the section entitled COMMERCIAL GENERAL LIABILITY CONDITIONS, the Condition entitled Other Insurance, this insurance is excess of all other insurance available to the additional insured whether on a primary, excess, contingent or any other basis. However, if this insurance is required by written contract to be primary and non-contributory, this insurance will be primary and non-contributory relative solely to insurance on which the additional insured is a named insured. V. Solely with respect to the insurance granted by this endorsement, the section entitled COMMERCIAL GENERAL LIABILITY CONDITIONS is amended as follows: The Condition entitled Duties In The Event of Occurrence, Offense, Claim or Suit is amended with the addition of the following. - Any additional insured pursuant to this endorsement will as soon as practicable: s z u http://fortnnet-ci.cna.com/glhtm/scn 12800.htm 1 /28/2016