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HomeMy WebLinkAbout201461 CONSTRUCTION CONCEPTS INC - INSURANCE CERTIFICATE (11)A� ® CERTIFICATE OF LIABILITY INSURANCE °9�22�Zo17 ) 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 endorsements . PRODUCER CONTACT NAME: KarOle Peters Ewing -Leavitt Insurance Agency, Inc. PHONE (970)679-7355 FAX No,C No:(866)237-2178 4090 Clydesdale Parkway ADDRIESS:karole-peters@leavitt.com Suite 101 INSURERS AFFORDING COVERAGE NAIC # Loveland CO 80538 INSURERA:Cincinnati Insurance Co 10677 INSURED INSURER B :Pinnacol Assurance 41190 Construction Concepts Inc INSURER C-Atlantic Specialty Insurance 27154 14125 Mead Street Longmont CO 80504 I INSURERF: rOVFRAr;FS rFRTIFIr ATF NI IMRFR•17-18 nPDATE DC\/ICIn AI All IIIADCD. 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 ADDL SUBR POLICY EFF POLICY NUMBER POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑X OCCUR Blkt Additional Insured X EPP0162368 10/1/2017 10/1/2018 EACH OCCURRENCE $ 1,000,000 DAMAGERENTED PREMISESS( Ea occurrence $ 500,000 X MED EXP (Any one person $ 10,000 X Blkt Waiver of Subro PERSONAL BADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X JPRO- POLICY LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED AUTOS HIRED AUTOS 1xx Blkt AI Blkt WOS X EPP0162368 10/1/2017 10/1/2018 COMBINED SINGLE LIMIT a Ea ccident $ 1,000,000 $ X BODILY INJURY (Per person) BODILY INJURY Per accident) $ X PROPERTY DAMAGE Per accidentX $ $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE EPP0162368 10/1/2017 10/1/2018 EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2r00,000 DED I X I RETENTION 0 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA 4031745 Blanket Waiver of Subrogation 7/1/2017 7/1/2018 X STAT TE OT ERH E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 C Builders Risk - Reporting 790-01-03-05-0006 10/l/2017 10/1/2018 Any One Structure ($1,000 ded) $1 , 500 , 000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Oak Street Restrooms. The City of Fort Collins is named as additional insured on the general liability and auto liability as regards work performed by the insured per written agreement. l,tK I It -ILA It: nuLLJtK City of Fort Collins 214 North Mason Street 2nd Floor Fort Collins, CO 80524 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 Karole Peters/KAPETE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INCMS nnlAnll AC� ® DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 9/22/2017 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 endorsements . PRODUCER CONTACT role Peters NAME: Ewing -Leavitt Insurance Agency, Inc. PHONE (970) 679-7355 EOv Fvc Nu: (866)237-2178 4090 Clydesdale Parkway noDREs,karole-peters@leavitt.com Suite 101 INSURERS AFFORDING COVERAGE NAIC # _ Loveland CO 80538 INSURERA:Cincinnati Insurance Co 10677 INSURED INSURER B :Pinnacol Assurance 41190 Construction Concepts Inc INSURER Atlantic Specialty Insurance 27154 14125 Mead Street INSURER D: Longmont CO 80504 1 INSURER F: COVERAGES CFRTIFICATF NIIMRFR-17-18 UPDATE RFVISION NIIMRFR- 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. 1�7R TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 7 OCCUR Blkt Additional Insured EPP0162368 10/1/2017 10/1/2018 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $ 500,000 X MED EXP (Any one person) $ 10,000 X Blkt Waiver of Subro PERSONAL BADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY JECT LOC X OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OPAGG $ 2,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS Blkt At X Blkt WOS EPP0162368 10/1/2017 10/1/2018 COMBINED SINGLE LIMIT ac Ea cident $ 1,000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PRPER cidentDAMAGE X $ A X UMBRELLA LIAB X OCCUR EXCESS LIAB I CLAIMS -MADE EPP0162368 10/1/2017 10/1/2018 EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2 00 000 DEC) I X I RETENTION 0 $ g WORKERS COMPENSATION AND EMPLOYERS' LIABILITY /E ANY PROPRIETOR/PARTNERXECUTIVE YIN OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N 1 A 4031745 Blanket Waiver of Subrogation 7/1/2017 7/1/2018 X PER OTH- TATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EM_P_LOYE $ 1, 000 , 000 E.L. DISEASE -POLICY LIMIT $ 11000,000 C Builders Risk - Reporting 790-01-03-05-0006 10/1/2017 10/1/2018 Any One Structure ($1,000 ded) $1 , 500 , 000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION City of Fort Collins Purchasing Division 215 N. Mason Street 2nd Floor Fort Collins, CO 80524 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 role Peters/KAPETE 09<&U�� ACORD 25 (2014101) INIRn9S 1on1nn11 © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD