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HomeMy WebLinkAboutGOLTZ ASPHALT - INSURANCE CERTIFICATE (3)ACORD.. CERTIFICATE OF LIABILITY INSURANCE OP ID D DATE(MM/DDIYY) LTZ-1 02/11/04 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 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 INSURER A: UNITED FIRE AND CASUALTY CO INSURER B. Plnnacol Assurance Goltz Asphalt Company INSURER C: 3466 E. County Road 20-C INSURER D. Loveland CO BU537 INSURER E: COVERAGES 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. INTR rypE OF INSURANCE POLICY NUMBER DOLICY ATE EFFIE MM/DD/YY E EXPIRATION DATE MMIDDIYY LIMITS A I— GENERAL LIABILITY FX COMMERCIAL GENERAL LIABILITY ~ I CLAIMS MADE � OCCUR 60075813 02/02/04 02/02/05 EACH OCCURRENCE $ 1 , 000 , 000 FIRE DAMAGE (Any one fire) $100,000 MED EXP (Any one person) s5,000 PERSONAL & ADV INJURY $ 1 , 000 , 00 0 GENERAL AGGREGATE s2,000,000 GENT AGGREGATE LIMIT APPLIES PER : POLICY PRO JR( LOC PRODUCTS - COMP/OP AGG $2,000,000 A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS ! SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS 60075813 02/02/04 02/02/08 COMBINED SINGLE LIMIT (Ea accident) $ 1 000 000 X BODILY INJURY I (Per person) $ X BODILY INJURY (Per accident) $ X PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO ', AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: AGG $ $ EXCESS LIABILITY F I OCCUR CLAIMS MADE DEDUCTIBLE RETENTION $ EACH OCCURRENCE $ AGGREGATE $ $ $ $ B WORKERS COMPENSATION AND EMPLOYERS'LIABILITY 4055471 04/01/03 04/01/04 X TORY LIMITS ER E.L. EACH ACCIDENT $500000 E.L. DISEASE - EA EMPLOYEE $500000 E.L. DISEASE -POLICY LIMIT $500000 OTHER I DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS CERTIFICATE HOLDER I N � ADDITIONAL INSURED; INSURER LETTER: CANCELLATION 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 , ACORD 25-S (7/97) ©ACORD CORPORATION 1988