HomeMy WebLinkAboutGOLTZ ASPHALT - INSURANCE CERTIFICATE (4)ACORD CERTIFICATE OF LIABILITY INSURANCk OP ID D DATE (MM07/0)
OLTZ-1 02/07/OS
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 INSURERS AFFORDING COVERAGE
Phone:970-482-7747 Fax:970-484-4165
INSURED INSURER A: UNITED FIRE AND CASUALTY CO
INSURER B: Pinnacol Assurance
Goltz Asph*lt Company INSURER C:
J & D Leasia , LLC
3466 E. County Road 20-C INSURER D:
Loveland CO SUS37
L 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.
INSR
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE MMIDD
POLICY EXPIRATION
DATE MMA)D
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE ® OCCUR
60075813
02/02/05
02/02/06
EACH OCCURRENCE
$1,000,000
FIRE DAMAGE (Any one fire)
$100,000
MED EXP (Any one person)
$ 5 , 000
PERSONAL &ADV INJURY
$1,000,000
GENERAL AGGREGATE
s2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY PRO LOC
JECT
PRODUCTS - COMP/OP AGG
$ 2 , 0 00 , 0 0 0
A
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OW NED AUTOS
SCHEDULED AUTOS
HIREDAUTOS
NON -OWNED AUTOS
60075813
02/02/05
02/02/06
COMBINED SINGLE LIMIT
(Ea accident)
$1,000,000
BODILY INJURY
(Per person)
$
X
X
BODILY INJURY
(Per accident)
$
X
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
ANY AUTO
AUTO ONLY - EA ACCIDENT
$
OTHERTHAN FA ACC
AUTO ONLY: AGG
$
$
A
EXCESS LIABILITY
X OCCUR CLAIMS MADE
DEDUCTIBLE
X RETENTION $ 10, 000
60075813
02/02/05
02/02/06
EACH OCCURRENCE
$ 11000,000
AGGREGATE
$
$
$
B
WORKERS COMPENSATION AND
EMPLOYERS'LIABILITY
4055471
07/01/04
07/01/05
X TORY LIMITS I I ER
E.L. EACH ACCIDENT
$500000
E.L. DISEASE - EA EMPLOYEE
$ 5 0 0 0 0 0
E.L. DISEASE -POLICY LIMIT
1 $ 500000
A
A
OTHER
Equipment Floater
Leased/Rented Eq
60075813
I
02/02/05
I
02/02/06
I
CntrEquip 553,257
I Leased/Re 150,000
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
L,CR I Iriw% 1 C ITVLUCIN pl I AUUI I IVNAL INZWKCU; INZWKCK L 11 ftK: toAnlI CLL IIUM
FTCCITY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
CITY OF FORT COLLINS DATE THEREOF, THE ISSUING INSURER WALL 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 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
PO BOX 580
FORT COLLINS CO 80522-0580 REPRESENTATIVES.
AtIFNQRIZFD REPQi. ,