HomeMy WebLinkAboutHAMMERSMITH STRUCTURES LLC - INSURANCE CERTIFICATEA� 6r DATE (MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE 8/11/2017
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 Cathy Baker
NAME: Y _
Moody Insurance Agency, Inc. (AH/C No,�tt1 (303)824-6600 (AIICC.No):(303)370-olla
8055 East Tufts Avenue E-MAIL ca}� baker@moodyins.com
ADDRESS: y' y
Suite 1000 INSURER(S) AFFORDING COVERAGE NAIC#
Denver CO 80237 INSURERAAmerican Builders Insurance Co anv 11240
INSURED INSURERS :Plnnacol Assurance 41190
Hammersmith Structures, LLC. INSURERC:
201 Commerce Drive INSURER D :
#2 INSURER E :
Fort Collins CO 80524 INSURERF:
rnvl=onr_Cc rFRTIGIrATF NIimF:u 6-17WC/17-18GL RFVISION NUMRFR:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN !SSUED 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MOLIICDY EFF POL ICY EXP LIMITS
LTR
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE � OCCUR
GLP017776903
8/15/2017
8/15/2018
EACH OCCURRENCE
$ 1,000,000
DAMAG
PR M SES EaEoccurrence
$ 100,000
MED EXP (Anyone person)
$ 5,000
PERSONAL & ADV INJURY
$ 1,000,000
GEML AGGREGATE LIMIT APPLIES PER:
POLICY a PRO LOC
X JECT
OTHER:
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS -COMP/OP AGG
$ 2,000,000
L
$
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
NON -OWNED
HIRED AUTOS AUTOS
COMBINED SINGLE LIMIT
Ea accident
$
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PRPPeOa R tDAMAGE
$
UMBRELLA LIAB
EXCESS LIAB
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
$
AGGREGATE
$
DIED RETENTION
$
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
YIN ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? ❑Y
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
N I A
4196562
10/22/2016
11/1/2017
X PER OTH-
STATUTE ER
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required)
City of Fort Collins
215 North Mason Street
Fort Collins, CO 80524
VHIYI..CLLH 1 IUIY
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
Cathy Baker/RYAMAR
U 1988-2014 AGURD GURPUKA I IUN. All rlgnts reservea.
ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
INS025 (201401)