HomeMy WebLinkAboutRays Four Seasons Concrete Corporation - Insurance CertificateA,CoRif CERTlFICATE OF LIABILITY lNSURANCE
OATE (MIWDOTYYYY)
2it 2025
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON TI{E CERTIFICATE HOLDER. TI{IS
CERTIFICATE OOES NOT AFFIRMATIVELY OR NEGATIVELY AMENO, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. TI.IIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: lf the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have AODITIONAL INSURED provisions or be endorsed
lf SUBROGATION lS WAIVED, subject to the terms and conditions ot the policy, certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certiticate holder in lieu of such endo6ement(s).
Dcnvcr co 8021I
Elina Fresquez
E (r0l) 122 0800 (303)322-0874
ADD efiesquez@madisoniNurance.nel
INSU RE R{S ) AFFORDING COVERAGE
INSURER A I UNITED SPECIALry INS CO 125t7
II{SURED
R.ys Four Scasons Concrele Corpomlion
Po Box 316
co 80621
IruSUNEN B: O\\'NIJRS INS CO 32',t00
INSURER C : PINNA(]OL ASSUR ,11 190
INSURER D
INSURER E
INSURER F
COVERAGES CERTIFICATE NUMBER REVISION NUMBER:
THIS IS TO CERTIFY TTI,AT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ASOVE FOR THE POLICY PERIOD
INDICATED NOTWTHSTANDING ANY REQUIREMENT TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT wlTH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED SY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOW! MAY HAVE BEEN REDUCED 8Y PAID CLAIMS
LTR INSD POLICY NUMBER LIMITS
x COMMERCIAL GENERAL LIABLIry
CLAIMSMADE OCCUR
GEN'L AGGREGATE LIMITAPPLIES PERI
PoLrcY El!5cq
OTHER:
LOC
x
02101 2026
EACH OCCURRENCE $1.000.000
PREMISES (Ea occunence)50.000$
MED EXP (Any one p€6on)$Excluded
PERSONAT A ADVINJURY s 1.000,000
GENERAL AGGREGATE S 2.000.000
PROOUCIS - COMP/OP AGG S 2.000.000
S
B
AUTOMOAILE LIABILITY
x ANY AUTO
OI^/NED
AUTOS ONLY
HIRED
AUTOS ONLY
SCHEOULED
AUTOS
NON OWNEO
AUTOS ONLY
.1622497fi)0 0?/0lr?ol5 0li 0l r2026
s r.000.000
BODILY INJURY (Per person)s
BODILY INJURY (Per ac{idenl)s
s
s
UMBRELLA LIAB
EXCESS LIAB
x OCCUR
CLAMSMADE BTN25621ri7 02/0 t,2025 02,01 2026
EACH OCCURRENCE s 1.000.000 00
x AGGREGATE s 1.000.000 00
DED RETENTION S
C
WORKERS COIPENSANON
ANO EiIPLOYERS' LIAB|LITY
ANY PROPRIETORPARTNER/EXECUTIVE
OFFrcEFYMEMBER EXCLUDED?
DESCRIPTION OF OPERATIONS below
4i.1621I 03i0i,:025 03,0r'2026
x STATUTE ER
E.L, EACH ACC OENT $r.000.000
E,L, D]SEASE EA EMPLOYEE $1.000.000
E.L. O SEASE POLICY LII',IT $1.000.000
B Inland Marine 7418.1 I90 02/01/2025 0l/01 2026
Leased & Rented
Equipment
Deductible
25.000
1.000
DESCRTPTION OF OPERATIONS / L@ATIONS / VEHICLES (ACORD 101, Addition.lR.m..ts Schedule, m.y be attach.d r, mors.p.c. B requiGd)
The City ofFort Collins is an Additional Insured as it pertairN the the General Liability coverage.
CERTIFICATE HOLDER CANCELLATION
Cit, ofFort Collins
Attn: Engineering Dcparlment
281 N College Avenuc
I Fort Collins CO 80524
SHOULD ANY OF THE ABOVE DESCRIBEO POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE wlLL SE OELIVEREO IN
ACCORDANCE w]TH THE POLICY PROVISIONS,
AUTHORIZEO REPRESENTANVE
EUr.' FrLt+4d
O 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORDACORD 25 (2016/03)
PROOUCER
Madison lnsurance Group
7600 E Eastman Ave Ste 500
TYPE OF INSURANCE
ATN256!0122 02/01,2025