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HomeMy WebLinkAboutBedrock, LLC - Insurance Certificate 2023-2025 AC© DATE(MM/DDNYYY) CERTIFICATE OF LIABILITY INSURANCE 07/10/2023 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 ACT NAME: CLIENT CONTACT CENTER FEDERATED MUTUAL INSURANCE COMPANY PHONE I HOME OFFICE:P.O.BOX 328 (A/C,No,Eat):888-333-4949 1A/c,Nol:5074464664 OWATONNA,MN 55060 ADDRIESS-CLIENTCONTACTCENTER FEDINS.COM INSURERS AFFORDING COVERAGE NAIC# INSURER A:FEDERATED MUTUAL INSURANCE COMPANY 13935 INSURED 188-044-2 INSURER B: BEDROCK,LLC INSURER C: 10611 HIGHWAY 257 SPUR — GREELEY,CO 80634-9001 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:434 REVISION NUMBER:5 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. _ II:SR TYPE OF INSURANCE ADDL SUBRI To POLICY NUMBER POLICY EFF POLICY EXP LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 CLAIMS•MADE �X OCCUR DAMAGE TO RENTED PREMISES $I00,000 MED EXP(Any one person) $10,000 A Y N 6115485 04/01/2023 04/01/2024 PERSONAL&ADVINJURv $1,000,000 GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY FyIX PR.- LOC PRODUCTS&COMPIOP AGO $2,000,000 IJEC OTHER: AUTOMOBILE LIABILITY COMBINED 51NOLE LIMIT $1,000,000 Ea acclden X ANYAUTO BODILY INJURY(Per Person) A OWNEDAUTOS ONLY A3UTEEDDULED N N 6115485 04/01/2023 04/01/2024 BODILY INJURY leer Accideno OS HIRED AUTOS ONLY NON-OWNED PROPERTY DAMAGE AUTOS ONLY11 X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $10,000,000 A EXCESS LAB CLAIMS-MADE N N 6115486 04/01/2023 04/01/2024 AGGREGATE $10,000,000 DELI I RETENTION WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN X PER STATUTE 7HER ANY PROPRIETOR/PARTNERI EXECUTIVE E.L EACH ACCIDENT $1,000,000 A OFFICE RIME MOEREXCLUDED4 N/A N 1814377 04/01/2023 04/01/2024 (Mandatory In NH) E.L DISEASE EA EMPLOYEE $1,000,000 li yes,describe under DESCRIPTION OF OPERATIONS below E.L DISEASE.POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) SEE ATTACHED PAGE I CERTIFICATE HOLDER CANCELLATION 188-044-2 434 5 CITY OF FORT COLLINS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED PO BOX 580 BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN FORT COLLINS,CO 80522-0580 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE O 1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ----"1 AGENCY CUSTOMER ID: 188-044-2 AC"RLY LOC#: ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMEDINSURED FEDERATED MUTUAL INSURANCE COMPANY BEDROCK,LLC 10611 HIGHWAY 257 SPUR POLICY NUMBER GREELEY,CO 80634-8001 SEE CERTIFICATE#434.5 CARRIER NAIC CODE EFFECTIVE DATE:SEE CERTIFICATE#434.5 SEE CERTIFICATE#434.5 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE POLICY COVERAGE AS OF 07/07/2023 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. GENERAL LIABILITY COVERAGE CONTAINS CG 25 03 DESIGNATED CONSTRUCTION GENERAL AGGREGATE LIMIT ENDORSEMENT APPLICABLE TO EACH CONSTRUCTION PROJECT AS REQUIRED BY WRITTEN CONTRACT OR WRITTEN AGREEMENT. ACORD 101(2008/01) O 2008 ACORD CORPORATION.All rights reserved. The ACORD name and fogo are registered marks of ACORD AC.gJRa DATE(MM/DD/YYYY) %.....,—' CERTIFICATE OF LIABILITY INSURANCE 02/23/2024 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 NAME CT CLIENT CONTACT CENTER FEDERATED MUTUAL INSURANCE COMPANY HOME OFFICE:P.O.BOX 328 (A PHONE.No,Eat):888-333-4949 FAX ,No):507-446-4664 OWATONNA,MN 55060 ADDRIESS:CLIENTCONTACTCENTER FEDINS.COM INSURERS AFFORDING COVERAGE NAIC# INSURER A:FEDERATED MUTUAL INSURANCE COMPANY 13935 INSURED 188-044-2 INSURER 8: BEDROCK,LLC INSURER C: 10611 HIGHWAY 257 SPUR — — GREELEY,CO 80634-9001 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:434 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. IRSR ILTR TYPE OF INSURANCE JADDLISUBRI' POLICY NUMBER IPOLICY EFF POLICY EXP LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 CLAIMS-MADE aOCCUR DAMAGE TccurreO RENTED PREMISES $100,000 MED EXP(Any one person) $10,000 A Y N 6115485 04/01/2024 04/01/2025 PERSONALS ADVINJURV $1,000,000 GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY f' 'EST ❑LOG PRODUCTS 6 COMP/OP AGG $2,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000 Ea acciden JANYAUTO BODILY INJURY(Per Person) AOWNED AUTOS ONLY AUTOESDULED N N 6115485 04/01/2D24 04/01/2025 BODILY INJURY(Per Accident) HIRED AUTOS ONLY NON-OWNED PROPERTY DAMAGE AUTOS ONLY X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $10,000,000 A EXCESS LIAB CLAIMS-MADE N N 6115486 04/01/2024 04/01/2025 AGGREGATE $10,000,000 DIED I RETENTION WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN X PER STATUTE OTHER ANY PROPRIETOR/PARTNER/EXECUTIVE A OFFICE RIME MEEREXCLUDED? N/A N 1814377 04/01/2024 04/01/2025 E.L EACH ACCIDENT $1,000,000 1M entletory In NH) E.L DISEASE EA EMPLOYEE $1,000,000 If yes,tlescNbe Index DESCRIPTION OF OPERATIONS below I E.I.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional 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. GENERAL LIABILITY COVERAGE CONTAINS CG 25 03 DESIGNATED CONSTRUCTIDN GENERAL AGGREGATE LIMIT ENDORSEMENT APPLICABLE TO EACH CONSTRUCTION PROJECT AS REQUIRED BY WRITTEN CONTRACT OR WRITTEN AGREEMENT. CERTIFICATE HOLDER CANCELLATION 188-044-2 434 0 CITY OF FORT COLLINS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED PO BOX 580 BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN FORT COLLINS,CO 80522-0580 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE - O 1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD DDN '`� i® CERTIFICATE OF LIABILITY INSURANCE 7TEIMM/03/03/ 0252025 Y) 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 PHONE -- -- HOME OFFICE:P.O.BOX 328 (AIC,No,EXt):888-333-4949 (A/C,Nol:507-4464664 OWATONNA,MN 55060 ADDRESS:CLIENTCONTACTCENTER@FEDINS.COM INSURERS AFFORDING COVERAGE NAIC J/ INSURER A:FEDERATED MUTUAL INSURANCE COMPANY 13935 INSURED INSURER B: BEDROCK,LLC INSURER C: 10813 HIGHWAY 257 SPUR GREELEY,CO 80634-9001 INSURER D. INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:434 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 I TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR .INSR WVD MMIDD!YVYY MMIDDIYYYV X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 CLAIMS-MADE OCCUR DAMAGE TO ELATED PREMISES $100,000 (Ea occurrence MED EXP(Any one person) $10,000 A Y N 6115485 04/01/2025 04/01/2026 PERSONAL&ADV INJURY $1,000,000 GENL AGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $'j 000 000 POLICY I X PEST ❑LOC OTHER: Imo' PRODUCTS&COMP/OP ACC $2,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $1,000,000 JANYAUTO BODILY INJURY(Per Person) AOWNED AUTOS ONLY SCHEDULED N N 6115485 04/01/2025 04/01/2026 BODILY INJURY(Per Accident) OS HIRED AUTOS ONLY NON-OWNED PROPERTY DAMAGE AUTOS ONLY Per Acctden0 X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $10,000,000 A EXCESSLU\B CLAIMS MADEN N 6115486 04/01/2025 04/01/2026 AGGREGATE $10,000,000 DED I RETENTION WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN X I PER STATUTE ETHER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L EACH ACCIDENT $1,000,000 A OFFICE RIME McEREXCLUDED7 N/A N 1814377 04/01/2025 04/01/2026 (Mandatory In NH) E.L DISEASE EA EMPLOYEE If yes,describe under $1,000,000 DESCRIPTION OF OPERATIONS below E.L DISEASE POLICY LIMIT 11,000,0()0 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Addlflonal 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. GENERAL LIABILITY COVERAGE CONTAINS CG 25 03 DESIGNATED CONSTRUCTION GENERAL AGGREGATE LIMIT ENDORSEMENT APPLICABLE TO EACH CONSTRUCTION PROJECT AS REQUIRED BY WRITTEN CONTRACT OR WRITTEN AGREEMENT. CERTIFICATE HOLDER CANCELLATION CITY OF FORT COLLINS PO BOX 580 434 0 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED FORT COLLINS,CO 80522-0580 BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE II O 1988-2016 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD