HomeMy WebLinkAboutAPPLIED CONCRETE SERVICE - INSURANCE CERTIFICATEOCT-23-2003 THU 03'15 PH SIX & GEVING FAX NO, 7209620942 P. 01
Ac 8p, CERTIFICATE OF LIABILITY INSURANCE OP ID B DnTE(MMIDD/YYYY)
APPLI-3 10 23 D3
PRODUCER— THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Six & Geving/Danver Office HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
390 Union Blvd. #650 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Lakewood CO 80228
Phone1720-962-0930 Fax1720-962-0942 INSURERS AFFORDING COVERAGE NAIC#
INSUHBD INSURFRA' 8'MC Insurance Companies
INWRERB Pinnacol Assurance
Applied Concrete Service, Inc. INSURER C.
Dave Elmer -- .... —._..-
794 Ventura St. #D INSURERD.
Aurora CO 80011
INSURER E;
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1'I IC
POLIL"IFS
or INSURAN Cr LISTED DFLOW HAVE,
BEEN 01SUED TO 711L INSURED NAMED
ABOVE FOR TO IF POLICY
PERIOD INOICA I ED.
NOTWI'YHSTANRING
TERM OIL CONDITION Or ANY
CONTRACTOR OTHER C )CUMENY W ITI
I RCSPECT TO WI1ICH
1HIS CERTIFICATE.. MAY
DE ISSUED OR
ANY
MAY
RFOUIRL'MEN
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I,
TI IL INSUKANCC AFFORDED OY THE
POLICIES DESCRIOCD HERFIN IG SUDJL-CT
TO ALL THE TERMS.
EXCLUSIONS AND CONDITIONS
OF SUP
POLICIES.
AGORr(:ATC LIMITS .^.I IO WN MAY I IAVC
BEEN RFOUCCO BY PAID CLAIMS.
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POLICY NUMOCR
POI.Tr$ir$FFECTIVE
DATE MM/OD/1'Y
OCICV E%PIR�TON
DATE MM/DDIYY
... .. LIMITS...__—.—
EACH OCCURRENCE S 11000,000
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"- COMMFRCIAL CLNFRN. LIABILITY
2X91 011
10/06/03
10/06/04
DAMAGFTOPEN I EU--..
_PR DMISES(F, OCCVTe Co)f100,000 _
CLAIMS MADE: �A OCCUR
MEDEXP(Anyoneperson) S5,000
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PE RSONALSADVINJURY $1,000,000
GENERAL AGGREGATE $2, OOO , DOO
CE N'L AGGrYLCATE LIMIT APPL IFS PER:
PRODUCTS-COMWOP AGO S2, 00,0, 000
__ POI ICY PR0 PRO. LOC
AUTOMODILE LIABILJTV
COMRINF.D DINGLE LIMIT S 1,000,00D
A
X ANY AUTO
2X97811
10/16/03
10/06/04
(Ceeeelden0 —�—_
A(1. OWNLU AUTOS
BODILY INJURY S
(Per parson)
W1 ILDVI FO AUTOS
HII(FR AUTUS
000ILY INJURY S
(Per eCCIdON)_—
NON-OWNEOAUTOS
PROPERTY DAMAGE S
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GARAGE IIAL+IIITY
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AU)'O ONI.V - EA, ACCIOFNT
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EXCGSSIUMBHULLjA LIABILITY
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EACH OCCURRENCE_
OCCUR I..-� CLAIMS MADE
AGGREGATE
IS
I IDI F.
f
CLUUC
l-'1'CNTIUN S
S
WORHICRS COMPENSATION AND
_
X TORY LIMITS I I FR.
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EMPLOYERS'LIABILFIY
4074183
10/07/D3
10/01/04
E.L•EACH ACCIDENT
"'--
410.0,000
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f 100, 000
ANY PROPRIFTOPJPAH'I NFFUCXCCUI IVE
OFFICr.R/MLMHFRF.XCLUUEO'
El, DISFAEC_ EA EMPLOYEE
Irye:0eacrelo vnJ°r
E.L. DISCASE - POLICY LIMIT
f500,000
SVO"IN, FROV131ONS k)Htm
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DESCRIP110N OF OPERATIONS I LOCATIONS [VEHICLES I EXCLUSIONS ADDED RY ENDORSEMENT I SPECIAL PROVISIONS
Certificate Holder is named as additional insured as respects project:
Spring Creek Trail Rehabilitation
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SHOULD ANY OFTHEABOVE DKSCRI13EDPOLICIES BECANCELLED BEFORF.TJIEEXPIRATION
DATE TIICREOf,THE ISSUING INSURER WILL ENDEAVORTO MAIL _10-DAYSWRITTEN
City of Fort Coll inB
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
C ame e B O I NB i l l 11
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURCR• ITS AGENT$ OR
215 N DGason St., 2nd Floor
FOE Collins CO 80522-0580
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE S
r
Sandra Ara o r
ACORD25(2001/08) -" VJ AL.veysjrcvnrunH nun I -Go
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