HomeMy WebLinkAboutCUTLER REPAVING - INSURANCE CERTIFICATE (4)ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID
DATE(MMIDDIYYYY)
CUTLR-1
07 31 03
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Schifman, Remley & Assoc., Inc
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
5201 Johnson Drive, Suite 500
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Mission KS 66205
Phone : 913-831-1777 Fax: 913-831-4730
INSURERS AFFORDING COVERAGE
NAIC #
INSURED
INSURERA: The Hartford
INSURER B: Hartford Fire Insurance Co
Cutler Repaving, Inc.
INSURERC: Twin CityFire Insurance Co.
921 E 27th Street
Lawrence KS 66046
INSURERD: ARCH Specialty Insurance Co
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.
INZK
LTR
RWU N
INSR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE MMIDDIYY
POLICY EXPIRATION
DATE MMIDDIYY
LIMITS
A
X
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE F-IOCCUR
37CQT0536
08/01/03
08/01/04
EACH OCCURRENCE
$ 1 , 000 , 000
PREMISES (Ea occurence)
s300,000
MED EXP (Any one person)
$ 10 , 00 0
PERSONAL & ADV INJURY
$ 1 , 000 , 000
GENERAL AGGREGATE
$2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY PRO-
JECT LOC
PRODUCTS-COMP/OP AGG
$2,000,000
B
X
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON-OWNEDAUTOS
37UFNZT0431
08/01/03
08/01/04
CO accident)
(EaCOMBINED SINGLE LIMIT
$1 000 000
i r
X
BODILY INJURY
(Per person)
$
BODILY INJURY
(Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
ANY AUTO
AUTO ONLY - EA ACCIDENT
$
OTHERTHAN EA ACC
AUTO ONLY: AGG
$
$
D
X
EXCESSIUMBRELLA LIABILITY
X OCCUR CLAIMSMADE
DEDUCTIBLE
X RETENTION $10 000
42ULP1411700
08/01/03
08/01/04
EACH OCCURRENCE
$ 1,000,000
AGGREGATE
$1,000,000
$
$
C
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
If yes, tlescriba under
SPECIAL PROVISIONS below
37WEQT0970
08/01/03
08/01/04
X TORY LIMITS I ER
E.L. EACH ACCIDENT
$500 000
E.L. DISEASE - EA EMPLOYEEI
$ 500 , 000
E.L. DISEASE -POLICY LIMIT
$500,000
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
RE: #5778, HOT -IN -PLACE RECYCLING PROJECT. CITY OF FORT COLLINS COLORADO,
THEIR RESPECTIVE ENGINEERS) AND CONSULTANT(S) ARE ADDITIONAL INSURED WITH
RESPECTS TO THE ABOVE REFERENCED POLICIES EXCEPT WORKERS COMPENSATION
REGARDING THE AFOREMENTIONED PROJECT.
FORTC-1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
THE CITY OF FORT COLLINS, CO IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
PURCHASING DIVISION
215 NORTH MASON STREET, 2ND FL REPRESENTATIVES.
FORT COLLINS CO 80524 AU RFLF%D REPjtESENTATff e-,, n
ACORD 25 (2001/08)