HomeMy WebLinkAboutROCKY MOUNTAIN PAVEMENT MAINTENANCE - INSURANCE CERTIFICATEACORD CERTIFICATE OF LIABILITY INSURANCE OP ID S
ROCKY08
DATE(MM/DD/YYYY)
05 Ol 07
PRODUCER
Omnivest Insurance Group
dba Peliton Insurance
4600 S. Ulster St. #1400
Denver CO 80237
Phone:303-771-1800 Fax:303-290-0884
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW..
INSURERS AFFORDING COVERAGE
NAIC#
INSURED
Rocky Mountain Pavement Maint.
2001 W. 64th Lane
Denver CO 80221
INSURER A: EmplOyerS II1Sllrance Grou
INSURER 8: **Colorado Casualty Ina Coe
INSURERC.
INSURER D:
INSURER E:
COVERAGFS
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR
NSR
TYPE OF INSURANCE
POLICY NUMBER DATEYMM DD/YY E
PDATE MM/DXPID/l Y)
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$ 1 , 000 , 000
PREMISES (Ea occurence
$100,000
A
X
GENERAL LIABILITY
CPP056768501
06/18/06
06/18/07
�"MERCIAL
CLAIMS MADE 41 OCCUR
MED EXP (Any one person)
s5,000
PERSONAL B ADV INJURY
$1,000,000
GENERAL AGGREGATE
$2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER'.
PRODUCTS - COMP/OP AGG
$ 2 , 000 , 000
POLICY X PRO LOC
JECT
A
X
AUTOMOBILE
LIABILITY
ANY AUTO
CPP056768501
06/18/06
06/18/07
COMBINED SINGLE LIMIT
(Ea accident)r
$ 1 OOO OOO
r
X
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY
(Per accident)
$
HIRED AUTOS
NON -OWNED AUTOS
PROPERTY DAMAGE
(Per accident)
$
GARAGE
LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
X
ANY AUTO
$
AUTO ONLY: AGG
EXCESS/UMBRELLA LIABILITY
EACH OCCURRENCE
$ 4,000,000
A
X
X OCCUR ECLAIMSMAOE
CUP05669201
06/18/06
06/18/07
AGGREGATE
$4,000,000
$
DEDUCTIBLE
$
X RETENTION $ O
A
WORKERS COMPENSATION AND
EMPLOYERS'LIABILITY
ANY PROPRIETOR/
9181218
04/24/07
04/24/08
TORY LIMITS X ER
E.L. EACH ACCIDENT
$50O 000
E.L. DISEASE -EA EMPLOYEE
$500,000
EXCLUDED?
Oyes, describe and EXCLUDED?
S yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE -POLICY LIMIT
I $SOO,000
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
City of Fort Collins is added as additional insured.
CERTIFICATE HOLDER CANCELLATION
CITOFTC
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
City Of Fort Collins
Purchasing Dept
PO box 580
NOTICE 70 THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
Ft Collins CO 80522
REPRESENTATIVES.
AU7 ED REPg S NTA7IVE
Al/VKU ZO (ZUU1/U5) VACORD CORPORATION 1988