HomeMy WebLinkAboutKIEFER CONCRETE - INSURANCE CERTIFICATEJUL 22 2004 14:16 FR TO 2216707 P.01/01
AC-Q D. CERTIFICATE OF LIABILITY INSURANCI�ErE- °"07/2z 04
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
PRODUCER ONLY AND CONFERS NO RIGHTS UPON THE CERTIFIC
Brown 4 Brown Inc - Ft Collins HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTE
125 8 Howes, 5th Floor ALTER THE COVERAGE AFFORDED BY THE POLICIES
P O aoa 2226
Fort Collins CO 80522-2226 INSURERS AFFORDING COVERAGE
Phone:970-482-7747 E'ax:970-484-4165
INSURE0 INSURERA MOUNTAIN STATES MUTUAL
INSURER 8: Pi.nnacol As8uranae
Kiefer Concrete Inc INSURER C:
360 Linden INSURER D.
Ft Collins CO 80524 INSURER E'
COVERAGES _..._
THE
ANY
MAY
POLICIES
,py��
POLICIES OF INSURANCE LISTED BELOWHAVE
REQUIREMENT T TERM OR CONDITION OF
PERTAIN, THE INSURANCE AFFORDED BY
AGGREGATE LIMITS SHOWN MAY
TYPE OFINSURANCE
BEEN ISSUED TO THE
ANY CONTRACT OR OTHER DOCUMENTT VATH
THE POLICIES DESCRIBED HEREIN IS SUBJECT
HAVE BEEN REDUCED BY PAID CLAIMS.
PDLICYNUMBER
RESPECT TO WHICH
TO ALL THE TERMS,
DATMM AI
THIS CERTIFICATE MAY
EXCLUSIONS AND CONDITIONS
DATE MDIYYDH
BE ISSUED OR
OF SUCH
.-
..�
LIMITS
EACH OCCURRENCE
S 1000000
A
GENERAL LIABILITY
X_ICOMMERCIALGENERALLIABILITY
CLAIMS MADE Cl OCCUR
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CDP0074434-03
01/01/04
01/01/05
FIREDAMAGE(AnY00rft)
$100000
MED EXP (Any one Person)
$ 5000
PERSONAL ADV INJURY
S 1000000
GENERAL AGOREGAT@
s 2000000REGATE
COMPIOP AGO
$2000000Y
LIMIT APPLIES PER:PRODUCTS-
X iE�Y LOCLE
LIABILITY
UTO
tG
BAP0074434-03
Ol/01/04
Ol/01/05
COMBINEb SINGLE LIMIT
(Es aco deM)WNED
S7.000000
AUTOS
BODILY INJURY
parson)DULED
$(Per
AUTOS
AUTOS
(Par ocaMent)
BODILYINJURYOWNED
AUTOS
PROPERTY DAMAGE
(Perawidanti
s
it
DARAG£LIABILITY
AUTO ONLY-EAACCIDENT
$ N.
OTHER THAN .EAACC
AUTO ONLY: AGG
$
--- ANY AUTO
8
A
EXCESS LIABILITY
x I OCCUR CLaMSMADE
UNB0074434-03
01/01/04
01/01/05
EACH OCCURRENCE
$4000000 _
AGGREGATE
$ 4000000
s _ _
DEOuCTIBLE
$
$
X RETENTION $ 10000
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
3068852
01/01/04
01/01/05
X YORY LIMITS ER
E.L EACH ACCIDENT
3500000
EL DISEASE - EA EMPLOYEE
$500000
E.L DISEASE -POLICY LIMIT
$500000
OTHER
DESCRIPTION OF OPERATIONSA.00ATIONSIVEHICLESW-XCLUSIONS ADDED BY ENDORSEMENTfSPECIAL PROVISIONS
Fax#221-6707
GERTIFIGATE RVLLILK LN I ADDITIONAL INSURED; INSUREKL IPM 4MI��rGV.V'� r",m
CTTYFT5 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL -U— DAYS WRITTEN
City of Fort Collins NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUY FAILURE TO DO 50 SKALL
P=chas ing IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR
P 0 Sox 580
Port Collins CO 80522 REPRESENTATIVE$. - -