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Home My WebLink AboutTHOUTT BROS - INSURANCE CERTIFICATEF'om: Sherise Frank At: CRS Insurance Brokerage FaxIO: 303-757-7719 To: City of Ft Collins Date: 8f262004 08:58 AM Page: 1 of 1 ACORD_ CERTIFICATE OF LIABILITY INSURANCE OF ID $ DATE(MWDDNYYY) THOUT-1 1 08/26/04 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE CRS Insurance Brokerage HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 6600 E. Hampden Ave., 2nd Flr. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Denver CO 80224 Phone:303-996-7800 Fax:303-757-7719 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A'. 16535 Surieh Aw�riean Luuranw Co Thoutt INSURER B. Aoerican GvarmN� s LSWilliy 16535 Contra ctors Inc Bros Concrete INSURER National Union Fire Ins Co Contra 5460 Tennyson Street INSURER Fireman's Fund Ins. Co. Denver CO 80212 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. II LTR RLPLI NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE IMM/DDI POLICY EXPIRATION DATE (MMIDDNYI LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X X COMMERCIAL GENERAL LIABILITY GL003758063 04/01/04 04/01/05 PREMISES(Eaoccurence) $ 300,000 CLAIMS MADE FX] OCCUR MED I (Any one person) $ 10,000 PERSONAL &ADV INJURY $1,000,000 X XCU Included GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $2,000,000 POLICY X PEA LOC B AUTOMOBILE X LIABILITY ANYAIURD BAP3758090 04/01/04 04/01/05 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ X X HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE (Per accident) $ GARAGE LIABILRY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY. AGG $ ANY AUTO 1 $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE s4,000,000 C X OCCUR CLAIMSMADE BES683644 04/01/04 04/01/05 AGGREGATE $4,000,000 $ $ DEDUCTIBLE X RETENTION $ 10 , 000 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE TORV LIMITS ER E L. EACH ACCIDENT $ EL DISEASE - EA EMPLOYEE $ OFFICER/MEMBER EXCLUDED? f yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ OTHER D Equipment Floater MZI98470904 04/01/04 04/01/05 Deduct $1,000 D Rented Equipment 1300,000 PER ITEM 04/01/04 04/01/05 ACV DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS City of Fort Collins is named as Additional Insured on the General Liability with respect to operations of the named insured for the certificate holder. 17FRTIFII Hni nFR ramr I I ATIPM CTYFCOL SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRA71ON DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN City Of Fort Collins NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Attn : Purchasing 215 N. Mason IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Ft. Collins CO 80524 REPRESENTATIVES. AU�ORIZED REPRE,BEN7AJjYE s r, 'Wmv ca Tcw vuo/ W H1+VRU 1.VRrUNA I III TSOU ..... THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY PRODUCER AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS Pinriacol Assurance CERTIFICATE DOES NOT AMEND. EXTEND OR ALTER THE COVERAGE E Lowry Blvd AFFORDED BY THE POLICIES BELOW. LAVER CO 80230-7006 COMPANIES AFFORDING COVERAGE mmpANY A Pinnacol Assurance INSURED THOUTT BROS CONCRETE CONTRACTORS INC COMPANY B 5460 TENNYSON ST mmp� DENVER CO 80212 C . NXs u.. .... ...... .. ....... ..... - ABOVE FOR THE POLICY PERIOD INDICATED, THIS IS To CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED NOTWITHSTANDING ANY REQUIREMENT, TERM AND 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 CO I TYPE Of INSURANCE LIABILITY CLAMS MADE Lj OccYrE OWNER'S & MOT ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRER AUTOS NON-OWNEDAUTOS POLICY NUMBER I POLICY EFFECTIVE I POLICY EXPIRATION BODILY INJURY BODILY INHJRY LIMITS AM AUTO BACH ACIDENT 0 - AGGRE26YE EACH OCCURRENCE EXCESS LIABILITY AGGREGATE UMBRELLA FORM OTHER THAN UMBRELLA FORM WC STATU OTHER X WORKERS COMMMATION AND Li TORY LIMITS A EWLOYELS'LIABILM 2033000 11/01/2003 11/01/2004 THEPROPRIETORIPART14ERS' E] INCL EL DISEASE -POLICY LIMIT �1.000000 OTHER DESCRIPTION OF OPERATIOMiLOCATIONSNEHICLESISPECIAL ITEMS SEE BACK OF CERTIFICATE FOR CLASS COVERAGE AND OWNERSHIP COVERAGE DETAIL 713967 CITY OF FORT COLLINS 281 N COLLEGE AVENUE FORT COLLINS CO 80522-0580 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL DAYS WRITTEN NOTICE It) THE CERTIFICATE HOLDER NAMED TO THE LEFT. RT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR AUTHORIZED REPRESENTATIVE Jolui Utirein ORTEGAD CSR %4" 1012VO M:33-M 203- o U[a W: 12113;1n 12":W 'AN1135 ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID S DATE(MM/DD/YYYY) THOUT-1 08 26 04 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE CRS Insurance Brokerage HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 6600 E. Hampden Ave., 2nd Flr. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Denver CO 80224 Phone:303-996-7800 Fax:303-757-7719 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA: Zurich American Insurance Cc 16535 INSURER B: American Guarantee a Liability 16535 Thoutt Bros Concrete INSURERC: National Union Fire Ins CO Contractors Inc 5460 Tennyson Street INSURERD: Fireman's Fund Ins. Co. Denver CO 80212 COS 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. LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE POLICYMMIDDFFEC POLICY EXPIRATION DATE MMIDDIYY LIMITS A X GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE 41 OCCUR X XCU Included GL003758063 - 04/01/04 04/01/05 EACH OCCURRENCE $ 1, OOO, OOO PREMISES (Ea occurence) s300,000 MED EXP (Any one person) $ 10 , 0 00 PERSONAL &AOV INJURY S1,000,000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X ECT LOC PRODUCTS - COMP/OP AGG s2,000,000 B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIREDAUTOS NON-OWNEDAUTOS BAP3758090 04/01/04 04/01/05 COMBINED SINGLE LIMIT (Ea accident) $ 1, 000, 000 X BODILY INJURY (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 $ S C EXCESSIUMBRELLA LIABILITY X I OCCUR CLAIMSMADE 0DEDUCTIBLE x RETENTION $10,000 BE5683644 04/01/04 04/01/05 EACH OCCURRENCE s4,000,000 AGGREGATE s4,000,000 $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE EXCLUDED? OFFICER/MEMBEREXCLUDED? If yes, describe under SPECIAL PROVISIONS below TORY LIMITS I I ER E.L. EACH ACCIDENT $ E.L. D!SEP.SE- FA EMPLOYEE, $ E.L. DISEASE- POLICY LIMIT 1 $ D D OTHER Equipment Floater Rented Equipment MZI98470904 300,000 PER ITEM 04/01/04 04/01/04 04/01/05 04/01/05 Deduct $1,000 1 ACV DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS City of Fort Collins is named as Additional Insured on the General Liability with respect to operations of the named insured for the certificate holder. ------- --- --- ----- -- - CTYFCOL SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN City of Fort Collins NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Attn: Purchasing IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 215 N. Mason Ft. Collins CO 80524 REPRESENTATIVES. AIQtiORRED R,EPR�$ENT/rE AL:VKU ZO (ZUUTIUG)