HomeMy WebLinkAboutGOLTZ ASPHALT COMPANY - INSURANCE CERTIFICATE (2)acoRQ. CERTIFICATE OF LIABILITY INSURANCE OP ID L DADD
LTZ-1 07/107/13/04
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Brown & Brown Inc - Ft Collins ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
125 S Howes, 5th Floor HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P 0 Box 2226 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Fort Collins CO 80522-2226
Phone: 970-482-7747 Fax: 970-484-4165 INSURERS AFFORDING COVERAGE
INSURED INSURERA: UNITED FIRE AND CASUALTY CO
INSURER B: Pinnacol Assurance
Goltz Asphalt Company
J&D Leasing, LLC INSURERC:
3466 E. County Road 20-C INSURER D:
Loveland CO 80537
INSURER E:
(:CIVFRAr1FS
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
TYPE OF INSURANCE
POLICY NUMBER
DATE MMIDDIYr
DATE MMPDD✓YY N
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$1,000,000
A
X COMMERCIAL GENERAL LIABILITY
60075813
02/02/04
02/02/05
FIRE DAMAGE (Any one fire)
$100,000
CLAIMS MADE I -XI OCCUR
MED EXP (Any one person)
s5,000
PERSONAL &ADV INJURY
$1,000,000
GENERAL AGGREGATE
s2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS-COMPIOP AGG
s2,000,000
POLICY PROJECT F LOC
A
AUTOMOBILE LIABILITY
ANY AUTO
60075813
02/02/04
02/02/05
COMBINED SINGLE LIMIT
(Ea accident)
$1, 000,000
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
X SCHEDULEDAUTOS
X HIRED AUTOS
X NON -OWNED AUTOS
BODILY INJURY
(Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EAACC
$
ANY AUTO
$
AUTO ONLY: AGG
EXCESS LIABILITY
EACH OCCURRENCE
$ 1,000,000
A
X OCCUR L CLAIMS MADE
60075813
02/02/04
02/02/05
AGGREGATE
$1,000,000
$
DEDUCTIBLE
X RETENTION $ 10000
$
B
WORKERS COMPENSATION AND
EMPLOVERS'LIABILITY
4055471
07/01/04
07/01/05
X TORY LIMITS ER
E.L. EACH ACCIDENT
s500000
E.L. DISEASE - EA EMPLOYEE
$500000
E.L. DISEASE -POLICY LIMIT
s500000
OTHER
A
Contractors Equip
60075813
02/02/04
02/02/05
Scheduled 553257
S ecial/ACV
Leased E 150000
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES!EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
FTCCITY
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
CITY OF FORT COLLINS
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN
WATER UTILITIES
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
ATTN: OPAL
PO BOX 580
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
FORT COLLINS CO 80522-0580
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
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