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HomeMy WebLinkAbout210509 LIGHTNING POOL CONSTRUCTIONCOI - City of Wheat Ridge (5)A`oRo° CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 8/5/2022 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: Laurance Bass Orcutt Insurance Group,PHONE LLC FA 303 233-2828 AIC No Ext : � � (AIC, No): ADDRESS: certificates@orcuttgroup.com 8361 Sangre de Cristo Rd, ste 200 INSURER(S) AFFORDING COVERAGE NAIC # EACH OCCURRENCE $ 1,000,000 INSURER A: Scottsdale Insurance Co 41297 Littleton CO 80127 INSURED INSURER B: NISIG Specialty Insurance USA Inc 24886 INSURER C: Pinnacol Assurance 41190 Lightning Pool Construction Inc. INSURER D: 5785 Cape Harbour Dr Suite 204 INSURER E: AUTOMOBILE ��// /C 1 INSURER F Cape Coral FL 339148639 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. LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS A x COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FRI OCCUR Wheat Ridge, CO, 80033 CPS7579538 05/13/2022 05/13/2023 EACH OCCURRENCE $ 1,000,000 UAIV PREMISES (Ea occurrence) $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO - LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS -COMP/OP AGG $ 2,000,000 $ B AUTOMOBILE ��// /C LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY /� AUTOS ONLY HNO1000135-00 05/13/2022 05/13/2023 (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ (Per accident) $ E x 7EXCESS UMBRELLA LAB LAB x OCCUR CLAIMS -MADE XBS0166537 05/13/2022 05/13/2023 EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 DED I I RETENTION $ Follows Form $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED?�Y (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA 4237076 05/11/2022 05/01/2023 )CIPER 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 I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 26 (2016/03) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Wheat Ridge ACCORDANCE WITH THE POLICY PROVISIONS. 7500 W. 29th Avenue AUTHORIZED REPRESENTATIVE Wheat Ridge, CO, 80033 © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 26 (2016/03) The ACORD name and logo are registered marks of ACORD