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HomeMy WebLinkAboutGOLTZ ASPHALT - INSURANCE CERTIFICATEACORD„ CERTIFICATE OF LIABILITY INSURANCE OP ID L LTZ 1 DA07/1DD 0 07/13/04 PRODUCER Brown & Brown Inc - Ft Collins 125 S Howes, 5th Floor 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 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 INSURED INSURERA: UNITED FIRE AND CASUALTY CO INSURERS: Pinnacol Assurance GO1tZ Asphalt Company J&D Leasing, LLC 3466 E. Countyp Road 20-C Loveland CO 80537 INSURER C: INSURER D: INSURER E: GOV 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 OF INSURANCE POLICY NUMBER DATE MMIDDIYY DATE MMIDDIYY 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 1XI OCCUR MED EXP (Any one person) $ 5 , 000 PERSONAL 8 ADV INJURY $ 1,000,000 _.. - GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY PRO LOC JECT AUTOMOBILE LIABILITY AjANY AUTO 60075813 02/02/04 02/02/05 COMBINED SINGLE LIMIT (Ea accident) $ 1 000 000 r r ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per person) $ HIREDAUTOS NON-OWNEDAUTOS BODILY INJURY (Per accident) $ X PROPERTY DAMAGE $ (Per accident) 1 GARAGE LIABILITY �'�I AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURRENCE $ 1 , 000 , 000 AGGREGATE $1,000,000 A X ..00CUR E]CLAIMS MADE 60075813 02/02/04 02/02/05 $ DEDUCTIBLE $ X RETENTION $ 10000 $ WORKERS COMPENSATION AND X WC S B EMPLOYERS' LIABILITY 4055471 07/01/04 07/01/05 LIMITS ER E.L. EACH ACCIDENT $ 500000 E.L. DISEASE - EA EMPLOYEE $500000 E.L. DISEASE -POLICY LIMIT $500000 OTHER A !Contractors Equip 60075813 02/02/04 02/02/05 Scheduled 553257 S ecial/ACV Leased Ea 150000 DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS roorre�rwry ur l Mtee. -- I ___ ___... _ 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 N"a ACORD 25 S (7/97) ©ACORD CORPORATION 1988