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Home My WebLink AboutADVANCED LINE SYSTEMS INC - INSURANCE CERTIFICATEpATE (MM1DDlYVri) ACORO� CERTIFICATE OF LIABILITY INSURANCE �� ` o,i2s�2o2a TF{�S CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGH75 UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE ROES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY T1iE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, ANU THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIdNAI INSURED, the policy(ies} must have ADDITIONAL INSURED provislons or be endorsed. li SUBROGATION IS WAIVED, subJect to the terms and condittons of the policy, certain policies may requlre an endorsement. A statement on this �ertiticate does not confer rights to the certificate holder in lieu of such endorsement�s). PRODUCER NTA T Mpody-Valley InsuranceAgenCy, InC. NAME: Moody-Valiey insurance Agency. Inc PHpkN Ex ;(970j 246-8300 �C No :(970) 242-1894 760 Horizon Drive. 5uite 302 E-MAIL �rtrequestgj@moodyins.com ADDRESS: tNSURER�S) AFFORUING COVERAGE NASC q Grand Junction CO 815Q6 iHsuRERA: American Select Insurance Co 19992 INSURED INSURER B: Pin�8C01 ASSUfdnC@ 41190 Advanced Lme Systems Inc iNSurteR C: �� Hawley Insurance Company 37974 Go Jamie Poe INSURER D: 121 S W 6th AVB INSLRER E: Broomfeld C� 8�02� INSURER F: COVERAGES CERTIFICA7E NUMBER: 24/25 Master REVISION NUMBER: 7HIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERI00 INDICATED NONNTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT W1TH RESPECT TO WNICH TNIS CERTIFICATE MAY BE ISSUED OR MAY PER7AIN THE INSURANCE AFFQRDED BY iHE POLICIES DESCRIBED HEREIN IS SUBJECT TOALL THE TERMS, EXCLUSIONS AND COND TiONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCEO BY PAID CLAIMS. ��7p �YPE OF INSURANCE INSD WVD POLICY NUMH£R MMIODY/YYYV MMlODIYYYY LfMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S �•000,000 CtAIMS-MADE �(k:Ci.R PREMiSES Eaoccurrence S 500,000 X WY Stop Gap-EL S,OOQ MED EXP (Arry one parson) S A Y TRA015342Y 01130l2024 01/30/2025 pERSONALBADVINJURV S 1•000,000 GEN'LAGGREGATELiMITAPPUESPER GENERALAGGREGATE S 2A00,000 X pOLICY � ECT a LOC PROWCTS-COMPfOPAGG g 2.000,060 OTHER WY Stop Gap-EL 5 1,000,000 AUTOMOBILE LIABIUTY COMBINEO SINGLE LIMIT 5 1,000,000 Ea accideM X ANYAUTO BOPILY INJURY (P9r per5ql) 5 A OWNED SCHEDULED TRA015342Y 01/3O/ZOZ4 O1/3O/ZOZS BODILV INJURY (Per acciAent) E AUTOS ONLY AUTOS HIRED v NON-0WNED PROPERTY pAMAGE S X AUTOS ONLY /� AUTOS ONLY Per accident S UMBREILA LIAB X OCCUR EACH OCCURRENCE � S,OOO,000 A X EXCESS LIAB CUIMS-MADE TRA015342Y Ol/30l202A 01/30/2025 AGGREGATE S 5,000,060 DEO X RETENTiON E� 5 WORKERS COMPENSATION X ST TUTE E�RH AND EMPLOYERS' LIABILITY y! H ANY PROPR�ETOR/PARTNEWEXECUTIVE E L EACHACCIDENT b 1,000,000 g OFFICERIAAEMBER ExCLUDED7 � N!A 4720673 02/01/2024 02/01/2025 (Mandatory In NHJ E L DISEASE • EA EMPLOYEE S 1,000,060 If yes, describe under 1,000,000 DESCRIP710N Of OPERA710NS below E L DISEASE - POLICY LIMIT S Blanket LimiVACV $896,374 Contraclors Equipment A TRA075342Y o1/3012024 01/30/2025 Deductible $500 DESCRIPTION OF OPERATIONS / LOCATIONS ! VEHICLES (ACORD 101, Additlonal Remarka Schedule, may be attached ff more apace la requfred) City of Fort Collins Engineering Dept 281 North College Ave PO Box 580 FaA Collins ACORD 25 (2016l03) SHOULD ANY OF TH� ABOVE OESCRIBED POLICIES BE CANCELLED BEFORE THE ExPIRATJON DATE THEREOF, MOTICE WILL 8E DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE CO 80522 �� v(.�,C,I.Q� l�}wI +(Jc,� -�ITjtQ j/Sf�f/% - � - �Q.. - - (J O 1968-2015 ACORD CORPORATION. All rights reserved. The ACORD name and Iogo are registered marks of ACORD AGENCY CUSTOMER ID: � — - - � � LOC #: '`��R�� ADDITIQNAL REMARKS SCHEDULE Page or AGENCY NAMEOINSURED Moody-Va11ey Insurance Agency, Inc. Advanced Line Systems, Inc POLICY NUMBER CARRIER NAIC GOOE EFFECTIVE OATE: ADUI I IUNAL KEMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 2$ FORM TITLE: Certificate of Liabildy Insurance: Notes Owners Jamie Poe Cody Sleinfeld, Colte Russell are excluded irom Workers Compensation coverage CONTRACTUAL LIABILITYAPPLIES PER POLICY TERMS AND CONDITIONS General Liability General Liability FormsAltached Include: Blanket Additional Insured status applies only to Ihe extent provided in iorm CG 20 10 Q4 13 and form CG 20 37 04 13 and form CG 7137 12 17 when required by writlen contracl Blanket Waiver of Subrogat�on applies only to the exlenl provided in form CG 7137 12 17 when required by writlen wnlracl Primary and Non-Contributory stat�s only ro the extent provided in form CG 7137 12 17 when required by wr�tlen contract Designated Pro�ect General Aggregate applies only to the extent provided in form CG 25 03 OS 09 when requ red by wntten conlrect Designated Location(s) General Aggregate applies only to the extent provided in form CG 25 04 A OS 09 Coniractors Pollution Liabibty: Coniractors Pollution Liabi ity - Insurer C: Ml. Hawley Insurance Company, NAIC 37974 Policy fVo EGLOOi0934, EHective 08l0912623 to 08l0912Q24. $2,000,000 Each Pollut�on lncident; $2.000,000 Aggregate L�mit 52,500 Per Claim peducSible Contractors Pollution L�ab�l�ty Forms Attached Include: Blanket Addilional Insured stai�s applies only to ihe exlenl provided in form CPL 701 03 23 when required by wniten conlract BEanket Waiver of Subrogation appiies only to the extent provided in form CPL 1Q1 Q3 23 when requ red by wntten contract Primary and Mon-Contributory status only to the extenl provided in form CPL 101 03 23 when required by written contract Auto Liability' Auto Liabilily FormsAttached Include� Blanket Additional Insured statvs applies only to the extent provided in (orm CA 70 77 10 13 when requ red by written contract Blanket Waiver of Subrogation applies only to the extent prov ded m form CA 04 44 10 13 when required by written contracl Primary 8 Ncn-Contribulory applies onty lo the extent prov.ded m form CA OA 49 11 16 when requ red by wntten contract Excess Liability Excess Liabili�y policy is on a follow form basis for the fo'lowmg underlying insurance coverages General Liab lity, Automobde Uabdity, and Empfoyers Liabilily Additional msured stalus wdl follow when reqwred by wntten contract nc�uding Pnmary and Non-Contributory status when requfred by written Worker's Compensation 359-8 From Attached Includes Blanket 1Nawer ot Subrogabon Status applies when reqwred by wntten conSract. IMPORTANT The pohcy forms referenced will be sent va emad only To oblain copies, please send your request with the email address to certrequestg�@moodyins com 1Q1 (2006/01) O 2008 ACORb CORPORATION. All rights reserved. Tha ACORD name and logo are registered marks of ACORO