HomeMy WebLinkAboutWINDSOR CUSTOM CONCRETE - INSURANCE CERTIFICATE (2)C-0-80. CERTIFICATE OF LIABILITY INSURANCE OP ID A DATE(MMIDD/YY)
NDS-4 08/18/04
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Brown/Raynor Corporation HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
5575 DTC Parkway, Suite 330 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Englewood CO 80111
Phone:303-771-2509 Fax:303-771-3110 INSURERS AFFORDING COVERAGE
INSURED INSURERA: National Fire & Marine
INSURER B: Pinnacol Assurance
Windsor Custom Concrete, Inc. INSURERC:
1218 W. Ash Ste A. INSURER D:
Windsor CO 60550
INCI IRFR R
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.
INSR
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE MMIDD//YY
POLICY EXPIRATIO
DATE MMIDDIYY N
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE® OCCUR
72LP155037
06/03/03
06/03/04
EACH OCCURRENCE
$ 1000000
FIRE DAMAGE (Any one fire)
$50000
MED EXP (Any one person)
$.5000
PERSONAL B ADV INJURY
$ 1000000
GENERAL AGGREGATE
$ 2000000
GENT AGGREGATE LIMIT APPLIES PER:
17 POLICY PROJECT- LOC
PRODUCTS-COMP/OP AGG
s2000000
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
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
S
AGGREGATE
$
g
$
B
WORKERS COMPENSATION AND
EMPLOYERS'LIABILITY
-
APP ID-9105929
06/04/03
06/04/04
TORY WC3 LIMITS ER
E.L. EACH ACCIDENT
$500000
E.L. DISEASE - EAEMPLOYEE
$500000
E.L. DISEASE -POLICY LIMIT 1
$500000
OTHER
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES!EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
Fax 970-221-6378
•. VI11. V LLLf. r rV,.
CITYFTC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL -ID_ DAYS WRITTEN
City of Fort Collins NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUTAXIIaRZX1ZMX D SHALL
Attn Nancy P O Box 580 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
Fort Collins CO 80522-0580 RE91%ENTATIVES.
ACORD 25S
TION 1988