HomeMy WebLinkAboutDream Construction Services IncA4COR6r CERTIFICATE OF LIABILITY INSURANCE
DATE(MM/DD/YYYY)
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
3/29/2022
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 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: Certificate Department
RSS Insurance Services, Inc
PHONE
3640 W 112th Ave
, !; 303-429-3561 N rvo :303 427-0611
Westminster CO 80031
_
E-MAIL
DRr=ss; certs@rss-insurance.com
INSURER AFFORDING COVERAGE NAIC #
INSURER A: Pinnacol Assurance 41190
INSURED DREACON-01
INSURER B: Continental Westem Ins CO 10804
Dream Construction Services, Inc.
-
9840 Gilpin St
INSURERC:
INSURER D :
Thornton CO 80229
OTHER:
INSURER E:
INSURER F :
GUVCKAL2CS Gt•KIII-IGAI t NLIMI31_K' 3771RA75R 12FVISInkI NIIIIMQC11-
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 TYPE OF INSURANCE ADDLISUBR POLICY EFF POLICY EXP
LTR POLICY NUMBER MM/DDIYYYY) fMMIDOffYYYi LIMITS
B X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE 1XI OCCUR
Y
Y CPA3160213-25
4/1/2022
4/1/2023
EACH OCCURRENCE $1,000,000
DAMA E
PREMISES Ea occurrence $ 300,000
MED EXP (Any one person) $ 10,000
.
PERSONAL & ADV INJURY $1,000,000
GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMITAPPLIES PER:
PRO -
POLICY D JECT F LOC
PRODUCTS - COMP/OP AGG $ 2,000,000
$
OTHER:
B
AUTOMOBILE
LIABILITY
CPA3160213-25
4/111022
4/1/2023
COMBINED SINGLE LIMIT
Ea accident $1 ,000,000
X
ANY AUTO
BODILY INJURY (Per person) $
ALL OWNED SCHEDULED
AUTOS AUTOS
BODILY INJURY Per accident) $
X
X NON -OWNED
HIRED AUTOS AUTOS
PROPERTY DAMAGE
fPer accident $
B
UMBRELLA LIAB
OCCUR
CPA3160213-25
4/111022
4/1/2023
EACH OCCURRENCE $ 5,000,000
AGGREGATE $
EXCESS UAB
CLAIMS -MADE
DED RETENTION $
$
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY �, I N
Y
4079165
4/1/2022
4/1/2023PER
OTH-
STATUTE ER
E.L. EACH ACCIDENT $ 1,000,000
ANY PROPRIETOWPARTNER/EXECUTIVE
OFFICERIMEMBER EXCLUDED?
N /A
E.L. DISEASE- EA EMPLOYEE $1,000,000
(Mandatory in NH)
If yes, describe under
E.L. DISEASE - POLICY LIMIT 1 $1,000,000
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
City of Wheat Ridge is an Additional Insured on the liability policy.
CERTIFICATE HOLDER CANCELLATION
City of Wheat Ridge
7500 W. 29th Ave.
Wheat Ridge 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 REPRESENTATIVE
U 1983-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD