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HomeMy WebLinkAboutCHAIREZ CONCRETE CONSTRUCTION - INSURANCE CERTIFICATEAC_ R ,M CERTIFICATE OF LIABILITY INSURANCE 09/07/2007 PRODUCER (970)679-7333 FAX (970)679-7377 Ewing -Leavitt Insurance Agency 4025 St Cloud Dr Suite 100 Loveland, CO 80538 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 Chairez Concrete Construction PO BOX 337181 Greeley, CO 80633 INSURER Auto Owners 18988 INSURLRB Pinnacol Assurance 41190 INSURER INSURER D INSURE R E COVERAGES 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 CONDI I IONS OF SUCH POLICIES AGGREGATE I IMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR eDD L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY 042332-74002438-07 09/08/2007 09/08/2008 EACHGCwRRENCE $ 1,000,000 X COMMERCIAL GENERALLiABILITY DAMAGE TO RENTED $-300,000 CLAIMS MADE O OCCUR MED EXP (Any one person) $ 10,000 A PERSONAL & ADV INJURY S 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN I AGGREGATE LIMIT APPLIES PER PRODUCTS COMPIOP AGO $ 2,000,000 POIICV ,P r7 LIC AUTOMOBILE LIABILITY ANY AViO COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY /Per person) $ AI L O WNF D AU f OS SCHFDU1 I D AU I OS HODII V INJl1R\ (Par acudent) $ Tilt D AU I OS NON ONMLD AUTOS PROPERTY DAMAGE filer accident) $ _ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OI HER THAN EAACC $ ANY AUTO $ AUTO ONLY AGO EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR ❑ CLAIMS MADE AGGREGATE $ Is $ DFDUCI Of $ RETENTION $ WORKERS COMPENSAI ION AND 4078558 Q3/0112007 D3/01/2008 1 WC SLL B EMPLOYERS LIABILITY ANYPROPRIIIDWPARINIRIIXFGUIIVL ELEP�HACCIDENT $ 1D0,DDD E I DISEASE EA EMPLOYEE $ 100,000 OFFIGLRIMFMBFR FXCI 11D1 O) If yes tlescnbe Ti SPECIAL PROVISIONS below EL DISEASE -POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS LOCATIONS I VE RUBLES I EXCLUSIONS ADDED BY ENDORSEMENT SPECIAL PROVISIONS ertificate holder is also additional insured CERTIFICATF HOI.DFR CANCFI I ATIF)N SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT City of Fort Collins BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 281 N College Ave OF ANY KIND UPON THE INSURER ITS AGENTS OR REPRESENTATIVES Fort Collins, CO 80524 AUTHORIZED REPRESENTATIVE Ashley Ord ACORD 25 (2001/08) ©ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED the policy(es) must be endorsed A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s) If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may regwre an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s) DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon ACORD 25 (2001/08)