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HomeMy WebLinkAbout551661 ELDER CONSTRUCTION INC - INSURANCE CERTIFICATE (4)A� " CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 5/26/2017 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 Ewing -Leavitt Insurance Agency, Inc. Clydesdale Parkway Suite 101 Loveland CO 80538 CONTACT Renee McReynolds NAME: Yn ZONNo Ext: (970) 679-7344 —FAX No: (866)425-6180 C.4090 ADDRESS:renee-mcreynolds@leavitt.com INSURERS AFFORDING COVERAGE NAIC # INSURERA:Cincinnati Insurance Co 10677 INSURED Elder Construction, Inc. 7380 Greendale Road Windsor CO 80550 INSURER B :Pinnacol Assurance 41190 INSURERC:Travelers Insurance Companies A19046 INSURERD: INSURER E : INSURER F COVERAGES CERTIFICATE NUMBER:17-18 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 ADDLrSUBR� POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MMIDDIYYYY MMIDD/YYYY� LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE � OCCUR TE PREMISES Ea olccur once $ 500,000 X MED EXP (Any one person) $ 10,000 Blanket WOS X EPP0196637 6/8/2017 6/8/2018 X Blanket Addl Insureds PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 Additional Insured form POLICY [X� PRO JECT ❑ LOC includes ongoing and PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: completed operations AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ A X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS X EPP0196637 6/8/2017 6/8/2018 BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ NON -OWNED X HIRED AUTOS X AUTOS $ X BIktWOS X BlktAddlInsureds X UMBRELLA LIAR X OCCUR follow form EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 A EXCESS LIAB CLAIMS -MADE DED RETENTION$ $ EPP0196637 6/8/2017 6/8/2018 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE incl Blanket Waiver of Subrogation X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 B OFFICERIMEMBER EXCLUDED? (Mandatory in NH) NIA 3229590 6/1/2017 6/1/2018 E.L. DISEASE - EA EMPLOYE $ 1,000,000 E.L. DISEASE - POLICY LIMIT ' $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below C Contractors' Equipment QT660-BF331235 6/8/2017 6/8/2018 $100,000 Leased/Rented Equip subj to $1000 deductible DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The City of Fort Collins is named additional insured as respects both General and Auto Liability policies. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Fort Collins Purchasing Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. P 0 Box 580 AUTHORIZED REPRESENTATIVE Fort Collins, CO 80522 R McReynolds/RESTEI��rn ACORD 25 (2014/01) INS025 (201401) ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD