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Home My WebLink AboutROBERTS EXCAVATION CORPORATION - INSURANCE CERTIFICATE 2020-2021p� oare (MMinorvvrr� � CERTIFICATE OF LIABILITY INSURANCE sr3��zozo THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY ANQ CONFERS NO RIGHTS UPON THE GERTIFIGATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALtEFt iHE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERT�FICATE OF INS[1RANCE DOES NOT CONSTITUTE A CONTRACT BHTWEEN THE ISSUINCy INSURER(Sy, AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLOER. IMPQRTANT: IF the certi�cate hoider is an ADDI710NAL INSUR�D, the policy(ies) must be endorsed. If SUBROGATION 4S WAIVED, subject to the terms and conditions of the policy, certain policies may require an cndorsement. A staterreent on this certifieate does not eonfer rights ta the certificate holder in lieu of such endorsement(s}. PRODUCER COMTACT NAME: Olson & Olson Ltd Pr,oHe �ax 5855 S Yosemite Street #200 �cr,�o. Exq• 303-867-2055 ,uc�o : 303-867-2074_ Greenwood Vilfage CO 801'11 aoos�Ess: certificates olsonandolson.com INSURED �aberts Excavaiion Corporation Roberts Excavating 1801 1 st Street Berthoud CO 80513 INSEIRER 51 AFFI INSURERA: PInf19COlA55lf�8flCe iiOBER-2 INSURER 6 : INSURER C : iNsuRFR o : INSl1RER E : NAIC # 4119fl COVERAGES CERTIFtCATE NUMBER: 306105090 REVISiON NUMBER: THIS IS TO CERTIFY THAT THf PdLICIES OF INSURAhCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAME� ABOVE FOR THE POLICY PERIOD IN�ICATEp NONNTHSTANDING ANY REQUIREMEMT. TERM OR CON�1710N OF ANY CONTRACT dR OTHER DOCUMENT VNTH RESPECT TO WHICH TH1S CER7IFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED 8Y THE POIICIES DESCRIBED HEREIN k5 SUBJECT i0 ALL THE TERMS EXCLUSIONS AND CON�ITIONS OF SUCH POLICI�S LIMf7S SFIOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NSR TypE OF INSIfRANCE A�O�§UBR POLICY EFF POLICY EXP ��M�T3 LTR 1 POLICY NUMBER MMl�D1YYYY MMlDDIYYYY COMMERCIAL GENERAL LIABILITY I EACH OCCtJRRENCE S CLAIMS-MADE OCCIIR GEN'L AGGREGATE LIMITAPPLIES PER POLICY PR�� LOC JECT OTHER AUTOMOBFLE LIABILI7Y ANY AUTO ALL ONMED AUTOS HIRE� AUTOS SCHE�ULED AUTOS NON•pWNED AUTOS UMBRELLA LIA6 EXCESS LIAB OCCUR CLAIMS-MADE p YVORKERS COMPEN514TION ANO EMPLOYERS' LIABILITY y! N ANY PROPRlETORlAARTNER/EXECUTIVE OFFICERIMEMBER EXCLUREP� � N! q (Mandatory in NH) If ves. tlesuihe untler 3245433 4!1l2;i20 { 4l112021 $ PERS6NAL & RDV INJURY S GENERALAGGREGA-E $ PRODUCTS � COMPIOP AGG S S COM81kED S NGLE L�MIT a Ea accident BOOILY NJURYIPerpersonl S BODILY NJURY IPer ecc+deMy S PROPERTY DAMAGE s {Par aocidenl S @ACH OCCURRENCE $ AGGREGATE S E L DISEASE - EA EMPLOYEEjI S 1 000,000 E L �ISEASE • POLICY LIMIT I S t o00 000 �ESCRIPTION OF OPERATIONS f LOCATIONS! VEHICLES (ACORD 101, Addition�l Remerks SeheAule, may 6e atlaehetl If more spaea 1� requlreE} 5ee Attached... C�RTIFICATE CANCELLATION SHOULD ANY OF THE ABOVE �ESCRIBED POLECIES BE CANCELLED BEFORE THE EXPIRATION dATE TH�REdF, NpTICE WILL BE DELIVERED IN ACCORaANCE WITH THE POLICY PROVISIONS. City of Fort Collins 215 N Mason St Fort Collins CO 80521 ACORD 25 (2074101) AUTHORI;ED REPAESENTpTIYE �� 1988-2014 ACORD CORPORATION. All rights reservei The ACORD name and fogo are registered marks of ACORD 4co � �� GENCY �Ison 8 Olson Ltd OLICY NUMBER ARRIER EFFECTIVE �ATE: ►DdIT10NAL REMARKS HIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACQRO FORM, ORM NUMBER: z$ FORM TISL�: CER7IFICAT� OF LIABILITY INSURANCE Page � of � fORKERS COMPENSATION rC000313 Form Attached inGudes: anket Wai�er of Subrogation applieS when required by wntten contrad� 1PORTANT: �e policy forms referenced wdl be sent wa emad only, To obtain copies, please send your request with the email address ta o2@olsonandolson.com ontractor's �icense. AGENCY CUSTOMER ID: ROBER-2 LOC #: ADDlTIONAL REMARKS SCHEDULE NAMEDINSUREU Roberts �xcavation Corporadon Roberts Excavating 1801 1 st 5treet Berthoud CO 80513 NA11C CODE �CORD 107 (200$IQ7) � 2008 ACQRD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD