HomeMy WebLinkAboutGOLTZ ASPHALT J D LEASING - INSURANCE CERTIFICATEacoRv CERTIFICATE OF LIABILITY INSURANCk OP ID D DATE (MMlDD1YY)
OLTZ-1 02/07/05
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 O 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
INSURER A: UNITED FIRE AND CASUALTY CO
INSURER& Plnnacol Assurance
GoltZ LeasinggAsphalt Company INSURER C:
3466DELeCoungy Road 20-C
Loveland CO 8D537 INsuRERO:
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.
1W
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EF
DATE (M;wr
POLICY EXPIRATION
DATE III
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$1,000,000
A
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE ❑X OCCUR
60075813
02/02/05
02/02/06
FIRE DAMAGE (Any one fire)
$100,000
MED EXP (Any one person)
s5,000
PERSONAL &ADV INJURY
$1,000,000
GENERAL AGGREGATE
$ 2, 000, 000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY PROJECT LOC
PRODUCTS-COMP/OP AGG
$2,000,000
AUTOMOBILE
LIABILITY
A
ANY AUTO
60075813
02/02/05
02/02/06
COMBINED SINGLE LIMIT
(Ea accident)
$1,000,000
ALL OW NED AUTOS
SCHEDULED AUTOS
BODILY INJURY
(Per person)
$
X
x
HIREDAUTOS
NON -OW NED AUTOS
BODILY INJURY
(Per accident)
$
X
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
ANY AUTO
OTHER THAN EA ACC
$
AUTO ONLY: qGG
$
A
EXCESS LIABILITY
X OCCUR CLAIMS MADE
60075813
02/02/05
02/02/06
EACH OCCURRENCE
$ 11000,000
AGGREGATE
$
IDEDUCTIBLE
x RETENTION $ 10,000
$
$
WORKERS COMPENSATION AND
B EMPLOYERS'LIABILITY 4055471 07/01/04 07/01/05
X Twc ORY LIMITS ER
E.L. EACH ACCIDENT
$500000
E.L. DISEASE - EA EMPLOYEE $ 500000
OTHER
E.L. DISEASE - POLICYLIMIT
$ 500000
A Equipment Floater 60075813 02/02/05 02/02/06
A Leased/Rented E
DESCRIPTION OF OPERATIONSILOCATIONSJVEHICLES!EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
CntrEquip
Leased/Re
553,257
150,000
CERTIFICATF Hint nFa W. .....,�......, .......___ .-._..---._--- -'-.---. _-----
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 -1.- 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.
!ZED REPRESE
ACORD 25-S (7/97) 0AtORD CORPORATION 1988