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HomeMy WebLinkAbout168787 GOLDEN TRIANGLE CONSTRUCTION INC - INSURANCE CERTIFICATE (21)Client#: 33463 GOLTRIPC ACORDTM CERTIFICATE OF LIABILITY INSURANCE 112/28/2016 DATE (MM/DD/YYYY) 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(les) 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 Rd, Ste 330 South Greenwood Village, CO 80111 CONTACT NAME: PHONE 515 223-6800 FAX A/C, No, Ext): AIC, No E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Valley Forge Insurance Company 20508 INSURED INSURERB: Starr Indemnity & Liability Com 38318 Golden Triangle Construction, Inc 700 Weaver Park Rd INSURERC: Pinnacol Assurance Company 41190 INSURER D: AGCS Marine Insurance Company 22837 Longmont, CO 80501 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 SUB WVD POLICY NUMBER POLICY EFF MM/DD POLICY EXP MMIDD LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR PD Ded:5,000 6045613035 12/31/2016 12/31/2017 EACH OCCURRENCE $1 000,000 PREMISES Eaolccurrrence $100 000 X MED EXP (Any one person) $15,000 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRO - POLICY F_X1 ECT LOC OTHER: GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP/OPAGG $2,000,000 $ A AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS X HIRED AUTOS X NON -OWNED 6045613018 12/31/2016 12/31/201 (CEO, ccidMBINEDent SINGLE LIMIT a 1 �000 000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ Pe'accldZtDAMAGE $ B X UMBRELLA LIAB EXCESS LIAB N OCCUR CLAIMS -MADE 1000023343 12/31/2016 12131/2017 EACH OCCURRENCE $10000000 AGGREGATE $10 000 000 DIED I X RETENTION s0 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? � (Mandatory in NH) If yes. describe under DESCRIPTION OF OPERATIONS below Lease/Rent Equip Sched Equip Installation Fltr N / A 4197806 1/01/2017 01/01/2018 X PER OTH- E.L. EACH ACCIDENT $1 000 000 E.L. DISEASE - EA EMPLOYEE $1 000 000 E.L. DISEASE - POLICY LIMIT $1,0001000 _ D MX193070875 12/31/2016 12/31/201 $100,000/$5,000 ded ACV, less $5,000 ded $100,000/$5,000 ded DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) RE: Contractors License III;0JIl14V City of Fort Collins SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ± THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 215 N. Mason ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 580 Fort Collins, CO 80524 AUTHORIZED REPRESENTATIVE L�GA4A.11' 1. ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) 1 of 1 The ACORD name and logo are registered marks of ACORD #S259725/M259713 ATEC1