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HomeMy WebLinkAboutQUALITY PAVING COMPANY - INSURANCE CERTIFICATEACORDM CERTIFICATE OF LIABILITY INSURANCE 11/26/22003' PRODUCER (303)824-6600 FAX (303)370-0118 Moody Insurance Agency, Inc. 3773 Cherry Creek North Drive Y Suite 800 Denver, CO 80209-3804 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 9 INSURED Quality Paving Company PO Box 519 Henderson, CO 80640-0519 INSURERA: Charter Oak Fire Ins Co 25615 INSURERS: Travelers Indem Co of Ill 25674 INSURERC: Pinnacol Assurance INSURER D: INSURER E: rnvloo a cee THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDIN( 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. INSR DIT TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMBS GENERAL LIABILITY DTC07S4G6115C0F03 12/01/2003 12/01/2004 EACH OCCURRENCE $ j 0-00 00 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PRE $ 300,000. CLAIMS MADE Fx-1 OCCUR MED EXP (Any one person) $ 5 00 A X Bl kt Addtl Insd PERSONAL & ADV INJURY $ 1,000,00( X Blkt Waiver of Sub GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,00( POLICY F1 PROECT LOC J AUTOMOBILE LIABILITY ANY AUTO DT8107S4G611STIL03 12/01/2003 12/01/2004 COMBINED SINGLE LIMIT (Ee accident) $ 1,000 00 X BODILY INJURY (Per person) $ B ALL OWNED AUTOS SCHEDULEDAUTOS HIREDAUTOS NON -OWNED AUTOS X X BODILY INJURY (Peraccident) $ Bl nkt Addtl Insd X PROPERTY DAMAGE (Per accident) $ X Deductibles Vary GARAGE LIABILITY AUTO ONLY - EA ACCIDENT S OTHER THAN EA ACC AUTO ONLY: AGG $ ANY AUTO $ EXCESSIUMBRELLA LIABILITY DTSMCUP32SD2043TIL03 12/01/2003 12/01/2004 EACH OCCURRENCE S 5 000 00 X1 OCCUR CLAIMS MADE AGGREGATE $ S100010010 B $ $ DEDUCTIBLE X RETENTION $ 10,00 $ WORKERS COMPENSATION AND 2288480 12/01/2003 12/01/2004 X WC STATU- FR C EMPLOYERS' LIABWTY ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? E.L. EACH ACCIDENT $ SOO, OO E.L. DISEASE - EA EMPLOYEE S 500,000 Use, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT 1 $ S00 00 Bsed/Rented rCoTanH:ractors EquipmentQT660142D422ATIL0312/O1/2003 Equip 12/01/2004 Limit 3,953,063 Limit $250,000 Deductible $2,500 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ARDED BY ENDORSEMENT) SPECIAL PROVISIONS Certificate Holder is named as Additional Insured under the General Liability as respects work performed by Named Insured. rCRTICIrATC 14ni 111=0 rAMrCI I ATInki SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL City of Fort Collins 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, 281 N . College Ave BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY PO BOX S80 OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Fort Collins, CO 8OS22-0580 Consie Krumreich CISR CAKE ACORD 25 (2001108) ©ACORD CORPORATION 1988