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HomeMy WebLinkAboutHALCYON CONSTRUCTION INC - INSURANCE CERTIFICATE (4)ACO?R" CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 12/6/2016 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 endorsement(s). PRODUCER Flood and Peterson PO Box 578 Greeley CO 80632 CONTACT Jennifer Winter, CISR NAME: A",CNN . (970)506-3206 C No; FAX (970)506-6846 ADDRESS:JWinter@floodpeterson.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A:Trans ortation Insurance Company 20494 INSURED Halcyon Construction, Inc. 5212 Dry Creek Road Evans CO 80634 INSURER B Continental Casualty Company 20443 INSURERC:The Continental Insurance Company 35289 INSURERD:Pinnacol Assurance 41190 INSURER E : INSURERF: COVFRAGES CERTIFICATE NUMBER:CL1612614841 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 IN L POLICY NUMBER MWDDNYYY MM DO/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE E OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ 500,000 X MED EXP (Any one person) $ 15 , 000 BI/PD Ded: 10 , 000 6023707293 12/5/2016 12/5/2017 PERSONAL BADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2 , 000 , 000 PRODUCTS - COPO 2,000,000 PRO- POLICYX JECT LOC $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea acc dent $ 1,000,000 BODILY INJURY (Per person) $ B X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON OWNED X HIRED AUTOS X AUTOS 6023707262 12/5/2016 12/5/2017 BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ $ X Drive Other Car X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 51000,000 C EXCESS LIAB CLAIMS -MADE DED I X I RETENTION$ 10,000 $ 6023707276 12/5/2016 12/5/2017 D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/M(Mandatory in ER EXCLUDED? (Mandatory in NH) N / A 4160879 1/1/2017 1/1/2018 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) GERTIFIGA It: HULUtK %,Ar4%,r LLA I IVIY City of Fort Collins 300 LaPorte Avenue Fort Collins, CO 80521 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 ACORD 25 (2014/01) INS025 r?n14011 J Winter, CISR/JWINTE ©1988-2014 ACORD COKPORATIUN. All rights reservea. The ACORD name and logo are registered marks of ACORD