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HomeMy WebLinkAbout7.30 Inc WesternPipeWay Liability Insurance.pdf Client#:33245 730INCPC ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDlYYYY) 4117!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(les)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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER E CT Holmes Murphy-Colorado PHONE I FAX INC.No.E=t}: WC,No): 7600 East Orchard Rd,Ste 330 EMAIL South ADDRESS: Greenwood Village,CO 80111 INSURER(S)AFFORDING COVERAGE NAIC I INSURER A:Trim N 4 carowr 25658 INSURED INSURER 51 inn',"Parr Casaaey Co.Anon* 7.30,Inc.dba Western Pipeway INSURER C:PlnroedAnnanncen any 41190 P.O.Box 2098 AGea/nlnae,suru,nC.i.iy 22837 Breckenridge,CO 80424 INSURER D INSURER E:Charter o.k Fin Immanw Wn.any 25615 ` INSURER F: 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 POUCY 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 POUCIES DESCRIBED HEREIN 15 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POUCIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE IADDL SUB POLICY EFF POLICY EXP UNITS !)NSR WYD POLICY NUMBER (MMIDDIYYYY) (MMIDDIYYYY) A X COMMERCIAL GENERAL UABIUTY X 4TC07719B919IND18 01/0112018 0110112019LEACH OCCURRENCE s 1,000,000 CLAIMS-MADE 0OCCUR ISI fea rtence) s300,000 X PD Ded:55,000 MED EXP(Any one person) S 5,000 PERSONAL&ADV INJURY $1,000,000 GEM.- AGGREGATE OMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POUCY n JECaT n LOC PRODUCTS-COMP/OP AGG $2,000,000 I OTHER: S E AUTOMOBILE UABILITY 4T8107719B919COF18 01/0112018 01/0112019 IESaBlp EDISINGLELIMIT $1,000,000 X ANY AUTO BODILY INJURY(Per person) S OWNEONLY SCHEDULED BODILY INJURY(Per accident) S OS L AUTOS _S X A OS ONLY X AUTOS ONLNEY (Per PROPERTY DAMAGE $ B x UMBRELLA UAB X OCCUR CUP0J490392182S 04/11/2018 01/01/2019 EACH OCCURRENCE 54.000.000 EXCESS UAB CLAIMS-MADE AGGREGATE s4.000,000 DED l X RETENTION 5510,000 $ C WORKERS COMPENSATION 4048687 01101/2018 01101/2019 X �rEnt trtE 10TH- AND EMPLOYERS LIABILITYFR Y I N ANY PROPRIETOR/PARTNERIEXECt1TIVE E.L EACH ACCIDENT s 500,000 OFFICER/MEMBEREXCLUDED? n H (Mandatory In NH) E.L DISEASE-EA EMPLOYEE $500,000 If yes.describe under - DESCRIPTION OF OPERATIONS bdow E.LDISEASE-POUCYUMIT s500,000 D Leased/Rented SML93070030 01/0112018 01/01/2019 $150,000 Limit Equipment DESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES(ACORO 101,Additional Remarks Schedule,may be attached If mote space is required) Project Description:West Vail Sewer Main Improvements/Contract No 18.15.018 As required by written contract or written agreement,Colorado Department of Transportation,High Country (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION Eagle River Water&Sanitation SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN District ACCORDANCE WITH THE POLICY PROVISIONS. 846 Forest Road Vail,CO 81657 AUTHORIZED REPRESENTATIVE toltuavVOk eiL ©1988-2015 ACORD CORPORATION.Ail rights reserved. ACORD 25(2016/03) 1 of 2 The ACORD name and logo are registered marks of ACORD 1153526191M352295 BRON2 L0--q-, J.J � ��J �J,0 J _J�J �. �� 0 J5�J5 J�-_ - k...0 pTOWN OF VAIL V!L Contractor RegistrationTOWNOFa �atsizss Nanr: 7,30,Ira.I Prii al NmrrHarry Baum ikg +t 8tsixss Address: 68 Caaltiaal CL#B9 PO Box 2098 to rei Cay,State Zip: Bzckaridge,CO 80424 C/1:.) V Norm (970)453-6176 E-Mal: tarifr�u�cctcnpipmaycom F7strical and Plurbilgc mimeo's shall provide thea State ofColorado Elocerral or Phutftiig Lice sc umber `�] ,I Fie Pnxstian contractors shall ptoiidc oftbei•Val Fie and Fir y Seniors Contractor Rcgmtration timber lei) r lel L.#: r VHS Cory-actor Reg#: ])` 4�� r Plturttng Lie.#: ...- With acceptance of the issuance of this registration,the contractor agrees: I lttby notify dot i is my resp�bity to abide by the Val Toun Code and Iicasig rcquiflmis.Raffia-,I certify that I sla/animal t cilsman-e and Ing 1I1 rcgl canals per Vain Tann Code I undastand that fadtae to comply milt al town codes,hum,and regubtiors nay zea'it rcanation of my kerac Ix axing perakcs as l`/ �1 aLncd by hw. s. `— Ajps_e„....6 04/17/18 1(4-41 Oatc u 1�-- 04/30'2021 Registration Expiation Date i':::. tbnmmity Dovcblmcat Dcpaz ncnt 75 South Fmntapc Road Wcst-Mata,CO 81657-Phase:970-479.2139 (IV 1.401.4.7i..v 1....01.:171-.VL. aJ71.:17a.;01 7L && - Li ill; =AO 12:0,11ZiO1;.* — rZpig-./-a