HomeMy WebLinkAboutCarson Excavation LLC - Insurance Certificate ,4t�o® CERTIFICATE OF LIABILITY INSURANCE DATE /0312D/YYYY)
1/03/2025
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 rights to the certificate holder in lieu of such endorsement(s).
PRODUCER NAME: CLIENT CONTACT CENTER
FEDERATED MUTUAL INSURANCE COMPANY
HOME OFFICE:P.O.BOX 328 (A/C,No,Ext):888-333-4949 (A/C,No):507-446-4664
OWATONNA,MN 55060 E-MAIL
ADDRESS:CLIENTCONTACTCENTER@FEDINS.COM
INSURERS AFFORDING COVERAGE NAIC ft
INSURED INSURER A:FEDERATED MUTUAL INSURANCE COMPANY 13935
CARBON EXCAVATION LLC INSURER B:
6558 N COUNTY ROAD 11C INSURER C:
LOVELAND,CO 80538-1324 INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER:37 REVISION NUMBER:0
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 ADD
SUER
LiR TYPE OF INSURANCE INSR VD POLICY NUMBER NPOLIICY EFF POUC EX LIMITS
X COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE $1,000,000
CLAIMS-MADE OCCUR D
(Ee oAMAGE TO RENTED PREMISES $100,000
ccurrence
A MEDEXP(Anyoneperson) EXCLUDED
Y N 9338394 02/22/2025 02/22/2026 PERSONALT AOVINJURY $1,000,000
GENT AGGREGATE LIMIT APPLIES PER:POLICY R GENERAL AGGREGATE
ECT LOC $2 000 OOO
X � ❑
OTHER: PRODUCTS 6 COMPIOP ACC $2,000,000
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
JANYAUTO (Ea accident) $1,000,000
BODILY INJURY(Per Person)
AOWNED AUTOS ONLY]AUTaDULED N N 9338394 02/22/2025 02/22/2026 BODILY INJURY(Per Accident)
HIRED AUTOS ONLYED
NON
U OS ONLYY PROPERTY DAMAGE
(Per Accident)
�UMBRELLA LAB XOCCUR EACH OCCURRENCE $5,000,000
AEXCESSLIAB CLAIMS MADE N N 9338396 02/22/2025 02/22/2026 AGGREGATE
$5,000,000
IDLE) I RETENTION
WORKERS COMPENSATION
AND EMPLOYERS'LIABILITY YIN X I PER STATUTE OTHER
ANY PROPRIETOR/PARTNER/EXECUTIVE
A OFFlCER/MEMBER EXCLUDED? N/A N E.L EACH ACCIDENT $1,000,000
(Mandatory in NH) 1811838 02/22/2025 02/22/2026
If yes,describe under E.L DISEASE EA EMPLOYEE $1,000,000
DESCRIPTION OF OPERATIONS below
E.L DISEASE POLICY LIMIT $1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Addltlonal Remarks Schedule,may be attached If more space is required)
THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED SUBJECT TO THE CONDITIONS OF THE ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU ENDORSEMENT FOR GENERAL LIABILITY.
CERTIFICATE HOLDER CANCELLATION
ATTN:ENGINEERING DEPARTMENT 37 0
CITY OF FORT COLLINS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
281 N COLLEGE AVE BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
FORT COLLINS,CO 80524-2404 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
AI e
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ACORD 25(2016l03) The ACORD name and log
o are registered marks of ACORD