2019-01-09_PERMIT FILE - M2019002

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ACOP CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) llla.� 1 1 2/1 412 01 8 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 Commercial Risk Solutions PHONEValerie Brown FAX 6600 E Hampden Ave Ste 200 _(p&,N9,.E XUq,303-996-7847 �(A No):303-757-7719_ Denver CO 80224 E-MAIL /C - — — .APPRFss:_ VBrown(ti)Crsdenver.com ____I1NSUHRER(SJ AFFORDING COVERAGE NAIC# INSURER A:Travelers Prop Casualty of AM 25674 INSURED CASTL-1 INSURERS:Travelers Indemnity CO of CT 25682 Castle Rock Construction Company —of Colorado, LLC INSURER C_:Charter Oak Fire Insurance Co. 25615 6374 S. Racine Circle INSURER o:FARMINGTON CAS CO 41483 Centennial CO 80111 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER:1358381900 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 R7 EDUCED BY PAID CLAIMS, INSR -A4sn w n POLICY NUMBER I MMIDO��MM1Q0� LIMITS LTR TYPE OF INSURANCE C X COMMERCIAL GENERAL LIABILITY Y Y C0325D9449 12/31/2017 12/31/2018 EACH OCCURRENCE $1,000.000 CLAIMS-MADE I X ,OCCUR I DAMAGE TO RENTED PREMISES(Ea occurrence) _ _$_300,0_00 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER, GENERAL AGGREGATE $2,000,000 POLICY(�PRO- ( LOC - JECT PRODUCTS-COMPIOP AGG $2,000.000 OTHER. $ B AUTOMOBILE LIABILITY Y 810325D9449 12/31/2017 12/31/2018 COMBINED SINGLE LIMIT $1.000,000 .LEaaccldent)_ - _ -- X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY Per accident)_ AUTOS ONLY _ AUTOS ( ) $ X HIRED X NON-OWNED P420PEAtYDAMAGE $ AUTOS ONLY AUTOS ONLY (Per acadent) A X UMBRELLALIAB X OCCUR CUP325D9449 12131121117 12/11/2018 EACH OCCURRENCE $5.000.000 EXCESS LIAB CLA_I_MS-MADE AGGREGATE _ $5,000,000 DED X -RETENTION$ $ D WORKERS COMPENSATION UB9H13466A 1/1/2018 1/1/2019 X STATUTE _ ER AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L EACH ACCIDENT $500.000 OFFICER/MEMBEREXCLUDED9 N/A - - — (Mandatory In NH) E.L DISEASE-EA EMPLOYEE $500,000 It yyes,describe under - - - De OF OPERATIONS below E L DISEASE-POLICY LIMIT $500.000 A 'LeasedlRented Equipment 66031 12131/2017 12/31/2018 Limit1.000,000 Special Form/RC Deductible 5,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) RE: Colorado Project No.NHPP 0705-082,Project Code#21878,Contract Routing No. 19-HA4-2G-00058 Colorado Department of Transportation is included as additional insured for ongoing operations on the General Liability and included as additional insured on the Auto Liability with respect to operations of the named for the certificate holder as required by written contract.General Liability coverage is primary and non-contributory.General Liability coverage includes a waiver of subrogation in favor of Colorado Department of Transportation.All policy terms,conditions and exclusions apply. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Colorado Department of Transportation ACCORDANCE WITH THE POLICY PROVISIONS. Region 4 Travis Miller 401 A Avenue#366 AUTHORIZED REPRESENTATIVE Limon CO 80828 01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD