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Home My WebLink About210459 AWALT CONSTRUCTIONAwalt Construction LLC - Certificate - City of Wheat Ridge�8 CERTIFICATE OF LIABILITY INSURANCE 0 /02/2022 W) 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 Pascal Burke Insurance Brokerage Inc. 2102 Business Center Drive., Ste. 280 Irvine, CA 92612 OL98468 CONTACT Pascal Burke NAME: PHE 877 893-7629 FAX (949) 340-8412 A/CONNo Ext): ( ) A/C No E-MAIL ADDRESS: insure@pbibinc.com INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: United National Insurance Company 13064 INSURED INSURER B: Kinsale Insurance Company 38920 Await Construction, LLC INSURERC: INSURER D: 10827 Ventura Ct INSURER E Commerce City„ CO 80022 INSURER F: $ 100,000 COVERAGES CERTIFICATE NUMBER: 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 OF INSURANCE ADDLSUBRPOLICTYPE IVSD WVD POLICY NUMBER EFF MM DD/YYYY ICY EXP MML DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE [X OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ 5,000 A Y PBC0000070 07/14/2021 07/14/2022 PERSONAL a ADV INJURY $ 1,000,000 AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 GEN'L X POLICY El PRO JECT ❑ LOC PRODUCTS - COMP/OP AGG $ 1,000,000 $ OTHER: AUTOMOBILE LIABILITY COM BINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLALIAB X OCCUR EACH OCCURRENCE $ 2,000,000 B X EXCESS LAB CLAIMS -MADE 0100192246-0 05/20/2022 07/14/2022 AGGREGATE $ 2,000,000 DED RETENTION $ $ WORKERS COMPENSATIONPER AND EMPLOYERS' LIABILITY Y / N OTH- STATUTE ER E.L. EACH ACCIDENT $ ANYPROPRIETOR/PARTNER/EXECUTIVE❑ OFFICER/MEMBER EXCLUDED? N/A E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE- POLICY LIMIT $ DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) All locations as required by written contract. CERTIFICATE HOLDER CANCELLATION City of Wheat Ridge SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 7500 W 29th Ave THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Denver, CO 80033 AUTHORIZED REPRESEN' @ 1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Acord Fonn #25 Page 1/1 AfTbilithr CERTIFICATE OF LIABILITY INSURANCE ki F 1 D"s zrzozz�" 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. U 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 Pinnacol Assurance 7501 E. Lowry Blvd Denver, CO 80230 CONTACT NAME. PHONE FAZ .1 E- MDA . supporb@pinna INBUSE s AFPoadNG Ea E MCI l l URERA: Pinnacol Assurance 41190 INSURED AWALT CONSTRUCTION, LLC INSURER B: 2600 S Parker Rd, Bldg 3-330, Aurora INSURER C: Aurora, Colorado 80011 INSURER D: INSURER E: PNEMISES Mal INSURER F: MEDIXPMan COVERAGES CERTIFICATE NUMBER: 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 CFINWMNCE AWLry antro SUBR MUI NBMBEB P.YEFF MOM EIIP UM"LTR COMMESCMLGENESALOABU_l EACH OCCURRENCE $ CLAMSMWUOCCUR PNEMISES Mal $ MEDIXPMan $ PERSONAL S ADV INJURY $ GENL AGGREGATE LIMIT APPLIES PER: GENEMLAGGREGII $ POLICY LOC LOC PRODUCTS-COMP/OPAGG $ $ nasi AMMOBILEIABII EeamNNEEDDIINGLE LIMIT E BODILYINJURYIParPew) $ ANYAUTO ONNEO 77 SCHEDULED AUTOS ONLY Pi BODILY INJORY(Pvrn imQ $ HIRED NONDWNED AUTOS ONLY ADTOSONLY PROPERTY DAMAGE Px ucale. E E UMBRELLA U.pCCUR EACH OCCURRENCE $ AGGREGATE $ MCMIIAB CWMSMADE DEO RETENTIONS $ .WR SCOMPENSATION ANGEMPWYERS'LIABILT' Y/N Y` BTNTDTE ERa- A ANYPROMILTORrvAR1NEPoE"BURRE OFRCERIMEMBERE%CWDED, Y� (Mndarory In NH) N/A N 4226611 IDIIDR021 10/102022 E.L EAGI ACCIDENT $ 100000 E.L.DISEASE-EAEMPLOYEE $ 100000 IIYs4 bncnbs unbx DESCRIPTION OF OPEMTIONSDI EL DISEASE -POLICY LIMIT $ 500000 DESCRIPTIONOFOPEMTIONS/LCUMMS/VEHICLES(ACORD1%,MdlbmlR=m S uk,n Wa the I1mmapam IemquireI Unless otherwise stated In the policy provisions, coverage In Colorado only. pulling s mntramts license only No work being done. CERTIFICATE HOLDER CANCELLATION City of Wheat Ridge 7500 W 29th Ave Denver„CO 80033 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 REORMEMATIVE Pinnacol Assurance @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD City of Wheat Ridge 7500 W 29th Ave Denver„ CO 80033 CERTIFICATE HOLDER COPY IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend, or alter the coverage afforded by the policies listed thereon. DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT (CONT) 4226611