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Home My WebLink AboutCUTLER REPAVING - INSURANCE CERTIFICATE (5)ACORD CERTIFICATE OF LIABILITY INSURANCE CSR LE °ATE(MM/°D/YYYY) CUTLR-1 06 22 04 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 Cutler Repaving, Inc. 921 E 27th Street Lawrence KS 66046 COVERAGES INSURERS AFFORDING COVERAGE INSURERA: The Hartford INSURER B: Hartford Fire Ins INSURERC: Twin City lire Insurance Co. INSURER D: INSURER E: Co NAIC # 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. Imbil LTR NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM/DD EXPIRATION POLICYNDATE MM/DDIYY LIMITS GENERAL LIABILITY EACH OCCURRENCE S1,000,000 A X COMMERCIAL GENERAL LIABILITY 37CQT0536 08/01/03 08/01/04 TMAGETURERTED PREMISES (Ea occurence) $300,000 CLAIMS MADE X❑ OCCUR MED EXP (Any one person) $ 10 , 000 PERSONAL B ADV INJURY $1,000,000 GENERAL AGGREGATE s2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG s2,000,000 ECT LOG POLICY X SEC B AUTOMOBILE LIABILITY ANY AUTO 37UENQT0431 08/01/03 08/01/04 COMBINED SINGLE LIMIT (Ea accident) $ 1 , 000 , 000 X BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: AGG $ ANY AUTO $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? 37WEQT0970 08/01/03 08/01/04 X ITORY LIMITS I ER E.L. EACH ACCIDENT s500,000 E.L. DISEASE - EA EMPLOYEE $500,000 If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $500,000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS *except 10 days for non payment of premium. Certificate holder is additional insured general liability as their interest may appear as respects liability arising from insureds operations with regard to the following project: Hot -In -Place Recycling Project Renewal of Bid No. 5778 CFRTIFICATF 14111 DER CANCELLATION 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 PURCHASING DIVISION IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR 215 NORTH MASON STREET, 2ND FL REPRESENTATIVES. Au H RIZRIZ D�NTATV �_ _ " / (�%�� FORT COLLINS CO 80524 ACORD 25 (2001/08) W ACORD GURPUKATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2001/08) CERTIFICATE OF LIABILITY INSURANCE CSR . -ACORD CUTLR-1 DATE'VIYY ' 062204 PRODUCER Schifman, Remley & Assoc., Inc 5201 Johnson Drive, Suite 500 Mission KS 66205 Phone:913-831-1777 Fax:913-831-4730 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC# INSURED Cutler Repaving, Inc. 921 E 27th .Street Lawrence KS 66046 INSURERA: The Hartford INSURER B: Hartford Fire Insurance Co INSURER C: ' rin City Fire insurance Co. INSURER D: 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. lNbK LTR RUU N INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MMIDDIYY POLICY EXPIRATION DATE MMIDD/YY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE X❑ OCCUR 37CQT0536 08/01/03 08/01/04 EACH OCCURRENCE $ 1 , 000 , 000 PREMISE (Eaoccurence) $300,000 MED EXP (Any one person) $ 10 , 000 PERSONAL & ADV INJURY $ 1 , 000 , 000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PROJECT 7 LOC PRODUCTS-COMP/OP AGG $2,000,000 B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS 37UENQT0431 08/01/03 08/01/04 COMBINED SINGLE LIMIT (Ea accident) $ 1 000 000 r 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 $ $ EXCESSIUMBRELLA LIABILITY OCCUR CLAIMS MADE DEDUCTIBLE RETENTION $ EACH OCCURRENCE $ AGGREGATE $ $ $ C WORKERS COMPENSATION AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below 37WBQT0970 08/01/03 08/01/04 X TORY LIMITS I I ER E.L. EACH ACCIDENT $500,000 E.L. DISEASE - EA EMPLOYEE $ 500, 000 E.L. DISEASE -POLICY LIMIT 1 $ 5 0 0 , 000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS *except 10 days for non payment of premium. Certificate holder is additional insured general liability as their interest may appear as respects liability arising from insureds operations with regard to the following project: Hot -In -Place Recycling Project Renewal of Sid No. 5778 CERTIFICATE HOLDER CANCELLATION THE CITY OF FORT COLLINS, CO PURCHASING DIVISION 215 NORTH MASON STREET, 2ND FL FORT COLLINS CO 80524 FORTC-1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIOI 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 50 SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. 25 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. 25