HomeMy WebLinkAboutGOLTZ ASPHALT - INSURANCE CERTIFICATE (2)acoRD CERTIFICATE OF LIABILITY INSURANCE OP ID L DATE(MMIDD/YY)
LT2-1 03/25/04
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 O Box 2226 1 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Fort Collins CO 80522-2226
Phone:970-482-7747 Fax:970-484-4165
INSURED
3466 E. County5Roadn20-C
Love
l:U V tKAlit,
INSURERS AFFORDING COVERAGE
INSURERA: UNITED FIRE AND CASUALTY 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.
ILTR
TYPE OF INSURANCE
POLICY NUMBER
DATE MM/DD/YY
DATE MM/DD/YY N
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$ 1 , 000 , 000
A
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE ❑X OCCUR
60075813
02/02/04
02/02/05
FIRE DAMAGE (Any one fire)
$100,000
MED EXP (Any one person)
$ 5 , 000
PERSONAL & ADV INJURY
$ 1 , Q OO , 0O0
GENERAL AGGREGATE
$2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS-COMP/OP AGG
$2,000,000
POLICY PRO LOC
JECT
A
AUTOMOBILE LIABILITY
ANY AUTO
60075813
02/02/04
02/02/05
COMBINED SINGLE LIMIT
(Ea accident)
$ 1 OOO OOO
r r
ALL OWNED AUTOS
X SCHEDULED AUTOS
BODILY INJURY
(Per person)
$
-- HIRED AUTOS
X' NON -OWNED AUTOS
BODILY INJURY
(Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EAACCIDENT
$
ANY AUTO
OTHER THAN EA ACC
$
$
AUTO ONLY: AGG
A
EXCESS LIABILITY
X OCCUR CLAIMS MADE
60075813
02/02/04
02/02/05
EACH OCCURRENCE
$ 1,000,000
AGGREGATE
$1,000,000
EDEDUCTIBLE
X RETENTION $ 10000
$
B
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
4055471
04/01/04
04/01/05
X TORY LIMITS ER
E.L. EACH ACCIDENT
$ 500000
E.L. DISEASE - EA FMPI.OYF..F.
$ 500000
E.L. DISEASE -POLICY LIMIT
$5000OQ
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL 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 00 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 _
ACORD 25-S
TIAN 19AA