HomeMy WebLinkAboutGOLTZ ASPHALT COMPANY - INSURANCE CERTIFICATEACORD CERTIFICATE OF LIABILITY INSURANCE OP ID D DATE(MMIDDIYY1
LTZ-1 06/01/05
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Brown & Brown Inc - Ft Collins ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
125 S Howes, 5th Floor HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P O Box 2226 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Fort Collins CO 80522-2226
Phone:970-482-7747 Fax:970-484-4165 INSURERS AFFORDING COVERAGE
INSURER A: UNITED FIRE AND CASUALTY CO
Goltz Asphalt CoINSURERB: Plnnacol Assurance
LEmpany
J 6 D Leasln , LLC INSURER C:
3466 E. Count Road 20-C INSURER D:
Loveland CO 80537
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
POLICYEFFECTIVE
DATE MMIDDIYY
POLICY EXPIRATION
DATE MMIDDIYY
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE 1*1 OCCUR
60075813
02/02/05
02/02/06
EACH OCCURRENCE
$ 1 , 000 , 000
FIRE DAMAGE (Any one fire)
$100,000
MED EXP (Any one person)
$ 5 , 000
PERSONAL & ADV INJURY
$ 1 , 000 , 000
GENERAL AGGREGATE
s2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY PROJECT F LOC
PRODUCTS - COMP/OP AGG
$ 2 , 000 , 000
A
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
60075813
02/02/05
02/02/06
COMB(Ea accident) SINGLE
ident)INED
$ 1 000 000
r r
BODILY INJURY
(Per person)
$
X
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
$
$
A
EXCESS LIABILITY
X OCCUR CLAIMS MADE
DEDUCTIBLE
X RETENTION $10,000
60075813
02/02/05
02/02/06
EACH OCCURRENCE
$ 1 , 000 , 000
AGGREGATE
$
$
$
B
WORKERS COMPENSATION AND
EMPLOYERS'LIABILITY
4055471
07/01/05
07/01/06
WC STATU-
X TORY LIMITS ER
E.L. EACH ACCIDENT
$500000
E.L. DISEASE - EA EMPLOYE
$500000
E.L. DISEASE -POLICY LIMIT
1 $ 500 000
A
OTHER
Equipment Floater
Leased/Rented
60075813
02/02/05
I
02/02/06
I
Ctr Eq $447,587
Leased/Re $150000
DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS -
_ I IVI\
FTCCITY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
CITY OF FORT COLLINS DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN
WATER UTILITIES NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
ATTN: OPAL
PO BOX 580 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
FORT COLLINS CO 80522-0580 REPRESENTATIVES.
Q'-* `( k*'
ACORD 25-S (71971
CORPnRATInN IOAA