HomeMy WebLinkAboutABC Asphalt, Inc. - Insurance Certificate i
AFRO® CERTIFICATE OF LIABILITY INSURANCE DATE
(MM/ DIY YY)
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 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 endorsements .
PRODUCER CONTACT
CRS Insurance Brokerage PHONE SCOtt Anderson, CIC _ — FAX
9780 S Meridian Blvd Suite 400 303-996-7833 ac No;303.757-7719
Englewood CO 80112 ADDRESS: sanderson@crsdenver.com
INSURERS AFFORDING COVERAGE NAIC p
INSURER A:Pinnacol Assurance 41190
INSURED ABCASPH•01 INSURER B:Selective Ins. Co. of America 12572
ABC Asphalt, Inc —
PO Box 1226 INSURERC:
Brighton CO 80601 INSURERD:
INSURER E:
INSURER F
COVERAGES CERTIFICATE NUMBER: 1106444448 REVISION NUMBER:
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 CCLAIMS,
ILTR TYPE OF INSURANCE AN DD SWV RI POLICY NUMBER INODD/YYYY MMIDD YYYY LIMITS
8 X i COMMERCIAL GENERAL LIABILITY Y S 2504937 2/3/2025 2/3/2028 EACH OCCURRENCE $1,000,000
---
I � CLAIMS-MADE (X�OCCUR �
.
DAMAGE TO RENTED
_ i �_PREMI�E�S.(E�QEr�rr nc L__ 500,000
MED EXP(Any one person) $15.000
r PERSONAL&ADV INJURY $1,000,000
G_E_N'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000.000_
(--x—1 I —I
POLICY t -- I JEROCT U LOC PRODUCTS-COMP/OP AGG $2,000,000 J
OTHER: $
B AUTOMOBILE LIABILITY S 2504937 2/3/2025 2/3/2026 COMBINED SINGLE LIMIT
X ANY AUTO
BODILY INJURY(Per person) $
ALL OWNED ASCHEDULED
AUTOS UTOS
BODILY INJURY(Per acadenl) $
X HIRED AUTOS X NON-OWNED j PROPERTY DAMAGE
$
B X UMBRELLA LIAR X S 2504937 2/3/2025 2/3/2026
OCCUR i EACH OCCURRENCE _$10.000.000
EXCESS LIAB CLAIMS_MADE AGGREGATE
DED X RETENTION$ I $
A WORKERS COMPENSATION 4175280 7/1/2024 7/112025 X PER OTH-
AND EMPLOYERS'LIABILITY YIN STATUTE ER
ANY PROP RIETOR/PARTNERIEXECUTIVE E.L.EACH ACCIDENT $1,000,000
OFFICER/MEMBER EXCLUDED? N I A
(Mandatory In NH) E.L.DISEASE EA EMPLOYEE $1,000,000
If yes,deRIPTION Oscribe unF OPERATIONS below der
D ESC E.L.DISEASE-POLICY LIMIT $1 000,000
B Leased&Rented S 2504937 2/3/2025 2/3/2026 Limit 100,000
Equipment Deductible 500
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required)
City of Fort Collins is included as additional insured on the General Liability with respect to ongoing operations of the named insured for the certificate holder as
required by written contract.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City Of Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS.
Attn: Engineering Department
281 N. College Avenue AUTHORIZED REPRESENTATIVE
Fort Collins CO 80524
01988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
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