HomeMy WebLinkAbout150588 WALSH CONSTRUCTION INC - INSURANCE CERTIFICATE (27)' 1 Page 1 of 2 oRo® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) / 07/27/2018 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 have ADDITIONAL INSURED provisions or 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 CONTACT NAME: Willis of New York, Inc. PHONE 1-877-945-7378 1-888-467-2378 c/o 26 Century Blvd 1A/C. Ha Ex0: Wx. No): E-MAIL cartificates@willis.com Box 305191 ADDRESS: @willia.com Nashville, TN 372305191 USA _ INSURERS AFFORDING COVERAGE NAICB INSURER A: Great Divide Insurance Company 25224 INSURED INSURERB: Federal Insurance Company 20281 Walsh Environmental, LLC 4949 Pearl E Circle, Suite 300 INSURERC: Indian Harbor Insurance Company 36940 Boulder, CO 80301 USA INSURER D: COVFRAGFS CFRTIFIrtATF NI IAARFR• W7003063 CCVICInLI All IIIAQCO. 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 ADDL SUBR - -- POLICY EFF POLICY EXP - - LTR TYPE OF INSURANCE jDaPOLICY NUMBER MM/DDNYYY A)D/YYYY LIMITS X COMMERCIAL G ENERAL LIABILITY CLAIMS -MADE - OCCUR EACH OCCURRENCE $ 3,000,000 DAMAGE O RENTED PREMISES Ea occurrence $ 1,000,000 X MED EXP (Any one person) $ 30,000 A Blanket Contractual Liability PERSONAL & ADV INJURY $ 3,000,000 Y GLP2005977-16 08/01/2018 08/01/2019 GEN'LAGGREGATE LIMIT APPLIES PER: POLICY[ JJPECOT FX7 Loc GENERAL AGGREGATE $ 3,000,000 PRODUCTS - COMP/OP AGG $ 3,000,000 I $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT a accident $ 1,000,000 X BODILY INJURY (Per person) $ ANY AUTO p OWNED SCHEDULED AUTOS ONLY AUTOS BAP2005983-16 08/O1/2016 08/01/2019 BODILY INJURY(Peraccident) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE r accident $ B UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 15, 000, 000 X I AGGREGATE $ 15,000,000 EXCESS LAB CLAIMS -MADE 7987-27-63 08/01/2019 08/01/2019 DED RETENTION$ Prod/Compl Ops. $ 15,000,000 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE Y / N OFFiCER/MEMBEREXCLUDED? N/A O - STATUTE ER -- $ E.L. EACH ACCIDENT j E.L. DISEASE - EA EMPLOYEE1 $ I, (Mandatory in NH) Ifyes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ C (Professional Liability PECO050283 00/01/2018 08/01/2019 Each Claim $1,000,000 Pollution Liabilty Each Occurrence $1,000,000 (Professional & Pollution Liab. Aggregate Limit $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) SEE ATTACHED %.cn I IF MIM i r_ nvLur_n t„ANL tLLA I IUN City of Fort Collins 215 North Mason Street P.O. Box 580 Fort Collins, CO 805220580 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 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD SR ID: 16509410 BATCH: 804946 2 of 2 234 AGENCY CUSTOMER ID: _ LOC #: _ Ai1kCCW" ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Walsh Environmental Willis of New York, Inc. , LLC _ 4949 Pearl E Circle, Suite 300 POLICY NUMBER Boulder, CO 80301 USA See Page 1 CARRIER NAIC CODE See Page 1 See Page 1 EFFECTIVE DATE: See Page 1 AUUI I IUNAL KLMAHINJ THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: _ 25_ FORM TITLE: Certificate of Liability Insurance Excess Liability coverage is following form and supports all evidences coverages except Pollution 6 Professional. RE: P1066 Environmental Services --- The City of Fort Collins is named as an additional insured on the general liability as required by written contract. INSURER AFFORDING COVERAGE: Great Divide Insurance Company NAIC#: 25224 POLICY NUMBER: CCP2005976-16 EFF DATE: 08/01/2018 EXP DATE: 08/01/2019 TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: Excess Pollution 6 Professional Aggregate Limit $11,000,000 (Pollution - Occurrence) Each Poll. Condition $11,000,000 (Professional (claims -made) Each Prof. Claim $11,000,000 ADDITIONAL REMARKS: Great Divide (Berkley) Pollution 6 Professional Liability policy is excess of the Indian Harbor (XL Catlin) Primary Pollution 6 Professional Liability policy. ACORD 101 (2008/01) U 2008 AGUHU cUHF'UHA I IUN. An rlgnts reservea. The ACORD name and logo are registered marks of ACORD SR ID: 16509410 BATCH. $ 4946 CERT: W7003063