HomeMy WebLinkAboutVOGEL - INSURANCE CERTIFICATE (5)' ACORDTM CERTIFICATE OF LIABILITY INSURANCE 06/18/2004YYY)
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Flood & Peterson Insurance Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
4821 Wheaton Drive HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P O Box 270370
Fort Collins, CO 80527
INSURED
Vogel Concrete Inc.
1313 Blue Spruce Dr #B
Fort Collins, CO 80524
C/1VFRAGFS
INSURERS AFFORDING COVERAGE
INSURERA: Pinnacol Assurance
INSURER B:
INSURER C:
INSURER D:
INSURER E:
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.
NSR
LTR
NOD'
NSR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE MWDD/YY
POLICY EXPIRATION
DATE MM/DD/YY
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$
COMMERCIAL GENERAL LIABILITY
DAMAGE TO RENTED
PREMI E E urt nc
$
CLAIMS MADE OCCUR
MED EXP (Any one person)
S
PERSONAL & ADV INJURY
$
GENERAL AGGREGATE
$
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
$
POLICY PRO
JELOG
AUTOMOBILE
LIABILITY
ANY AUTO
COMBINED SINGLE LIMIT
(Ea accident)
$
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULEDAUTOS
BODILY INJURY
(Per accident)
$
HIRED AUTOS
NON -OWNED AUTOS
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
$
AUTO ONLY: AGG
EXCESS/UMBRELLA LIABILITY
EACH OCCURRENCE
$
OCCUR ❑ CLAIMS MADE
AGGREGATE
$
S
$
DEDUCTIBLE
$
RETENTION $
A
WORKERS COMPENSATION AND
20$6$50
07/01/04
07/01/05
X WC YSTATU- OTH-
EfL
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
E.L. EACH ACCIDENT
$100,000
E.L. DISEASE - EA EMPLOYEE
S100,000
OFFICER/MEMBER EXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE - POLICY LIMIT
$500,000
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
CERTIFICATE HOLDER
City of Ft Collins Purchasing Dept
Attn: Jan
256 W. Mountain
Fort Collins, CO 80521
LD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL An DAYS WRITTEN
:E TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
W NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
ACORD 25 (2001/08) 1 of 2 #S285325/M285322 /V(S (VACORD CORPORATION 1988