HomeMy WebLinkAboutWINDSOR CUSTOM CONCRETE - INSURANCE CERTIFICATEACORD CERTIFICATE OF LIABILITY INSURANCE OP ID Al
NDS-4
DATE (MMIDD 0
08/19/4
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Brown/Raynor Corporation
5575 DTC Parkway, Suite 330
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
Englewood CO 80111
Phone:303-771-2509 Fax:303-771-3110
INSURED
INSURERA: National Fire & Marine Ins. Co
INSURER B: Pinnacol Assurance
INSURER C:
Windsor Custom Concrete, Inc.
INSURERD:
1218 W. Ash Ste A.
Windsor CO 60550
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.
LTR
TYPE OF INSURANCE
POLICY NUMBER
DATE MMIDDIYY
DATE MMIDDIYY EXPIRATION
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE �_x OCCUR
72LP163270
06/03/04
06/03/05
EACH OCCURRENCE
$ 1000000
FIRE DAMAGE (Any one fire)
$50000
MED EXP (Anyone person)
$ 5000
PERSONAL &ADV INJURY
$ 1000000
GENERAL AGGREGATE
$ 2000000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY PROJECT LOC
PRODUCTS-COMP/OP AGG
s2000000
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULEDAUTOS
HIRED AUTOS
NON -OWNED AUTOS
COMBINED SINGLE LIMIT
(Ea accident)
$
BODILY INJURY
(Per person)
$
BODILY INJURY
(Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
ANY AUTO
AUTO ONLY- EA ACCIDENT
$
OTHER THAN EA ACC
AUTO ONLY: AGG
$
$
EXCESS LIABILITY
OCCUR CLAIMS MADE
DEDUCTIBLE
RETENTION $
EACH OCCURRENCE
$
AGGREGATE
$
$
$
B
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
4069680
06/01/04
06/01/05
TORY LIMITS X ER
E.L. EACH ACCIDENT
s500000
E.L. DISEASE - EA EMPLOYEE
$500000
E.L. DISEASE -POLICY LIMIT
1 $500000
OTHER
DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
Fax 970-221-6378. Cert holder is named as additional insured as respects
liability.
4 Qm I Irl.^IQ nwL uC:R ri I ~W IIVNI INOUKCU: INJUKCK LC I I CK: l,M1Yl,CLLJIIIVI�
CITYFTC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL JJQ_DAYS WRITTEN
City of Fort Collins NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUTXXKZMXXKXMM SHALL
Attn Nancy IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
P 0 Box 580
Fort Collins CO 80522-0580 REP S TATIVES.
1988