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HomeMy WebLinkAboutANTLER CONSTRUCTION CO - INSURANCE CERTIFICATE (6)ANTLE-6 OP ID: KR ACOR© DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 08/01/2017 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 Phone:303-202-0082 NAMEACT Western Group Inc -Denver PHONE FAX 6425 West 44th Ave Fax: 303-202-0086 A/C. No. Ext): Alc No): PO Box 497 E-MAIL ADDRESS: Wheatridge, CO 80034 Jim Howes INSURERS AFFORDING COVERAGE NAIC 0 INSURER A: United Specialty Insurance Co. 12537 INSURED Antler Construction,Co. INSURER B : Auto -Owners Insurance CO 18988 546 SE 8th Street,Unit B4 INSURER C Loveland, CO 80537 INSURER D : INSURER E : INSURER F : _ r-c Drlrlr-Ar= KII IMRCD• RFVIRIntJ NI IMRFR- 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. IPOLICY EXP LTR TYPE OF INSURANCE ADDL SUER POLICY NUMBER MM DDY EFF MM DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A I X COMMERCIAL GENERAL LIABILITY ATN-ATL1760556 08/01/2017 08/01/2018 AMAGE El PREM SES Ea ocou ence $ 100,00 MED EXP (Any one person) $ 5,00 CLAIMS -MADE I —XI OCCUR PERSONAL & ADV INJURY $ 1,000,00 I GENERAL AGGREGATE $ 2,000,00 I GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,00$ r 1 POLICY PRO JECT LOC I I AUTOMOBILE LIABILITY B r ANY AUTO 14888439100 06/28/2017 06/28/2018 COMBINED SINGLE LIMIT Ea accident) _ BODILY INJURY (Per person) 1,000_,0001 $ BODILY INJURY (Per accident) h X ALL OWNED n SCHEDULED L— AUTOS AUTOS X� NON -OWNED HIRED AUTOS X AUTOS I $ PROPERTYDAMAGE Per accident $ I $ UMBRELLA LAB OCCUR i EACH OCCURRENCE $ AGGREGATE $ _ EXCESS LIAB_ CLAIMS -MADE — 0ED T1 RETENTION $ $ i WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN � ANY PROPRIETOR/PARTNER/EXECUTIVE WC STATU- TORY LIMITS ER E.L. EACH ACCIDENT $ E.L. DISEASE -EA_EMPLOYEE $ OFFICER/MEMBER EXCLUDED? ❑ ft"znd7tory r MH) N / A 1 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ I DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) I IFICATE HOLDER CITYFTC City of Fort Collins 330 S. College Ave. P.O. Box 580 Fort Collins, CO 80522-0580 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 Jim Howes U 1988-2U10 ACUKU GUKFUKA I IUN. All rlgnis reservea. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD