HomeMy WebLinkAboutWINDSOR CUSTOM CONCRETE - INSURANCE CERTIFICATE (4)AC-ORD.CERTIFICATE OF LIABILITY INSURANCE OPID A DATE (MM /YY)
NDS-4 08 19 04
PRODUCER
Brown/Raynor Corporation
5575 DTC Parkway, Suite 330
Englewood CO 80111
Phone:303-771-2509 Fax:303-771-3110
INSURED
Windsor Custom Concrete, Inc.
1218 W. Ash Ste A.
Windsor CO 60550
COVERAGES
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
INSURERA: National Fire 6 Marine Ins. Co
INSURER B: Plnnacol Assurance
INSURER C:
INSURER D:
INSURER E:
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.
INSR
LTR
TYPE OFINSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE MMIDDIYY
POLICY EXPIRATION
DATE MM/DDIYY
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE �X OCCUR
72LP163270
06/03/04
06/03/05
EACH OCCURRENCE
$ 1000000
FIRE DAMAGE (Anyone fire)
$50000
MED EXP (Anyone person)
$ 5000
PERSONAL B ADV INJURY
$ 1000000
GENERAL AGGREGATE
$ 2000000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY PRO LOC
JECT
PRODUCTS-COMP/OP AGG
$ 2000000
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
COMBINED SINGLE LIMIT
(Ea accident)
$
BODILY INJURY
(Per person)
$
BODILY INJURY
(Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
ANY AUTO
AUTO ONLY - EA ACCIDENT
$
OTHER THAN FA ACC
AUTO ONLY: AGG
$
$
EXCESS LIABILITY
OCCUR CLAIMS MADE
DEDUCTIBLE
RETENTION $
EACH OCCURRENCE
$
AGGREGATE
$
$
§
B
WORKERS COMPENSATION AND
EMPLOYERS'LIABILITY
4069680
06/01/04
06/01/05
TORY LIMITS X ER
E.L. EACH ACCIDENT
s500000
E.L. DISEASE -EAEMPLOYEE1
$500000
E.L. DISEASE -POLICY LIMIT
s500000
OTHER
DESCRIPTION OF OPERATIONSILOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Fax 970-221-6378. Cart holder is named as additional insured as respects
liability.
vc�urrvrrrc nvcvcn " wuvuwnHL mQUK=W; IMOUKCK LC I I CK; ygnIVGLL/1I lum
CITYFTC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL -IL- DAYS WRITTEN
City of Fort Collins NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUTXXXXUUEXRXM DSHALL
Attn Nancy IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
P O Box 580
Fort Collins CO 80522-0580 REP S TATIVES.
ACORD 25S (7/97)
1988