The URL can be used to link to this page

Home My WebLink About389648 A-1 CHIPSEAL COMPANY - INSURANCE CERTIFICATE (9)Client#- 20936 AICHIPS ACORD- CERTIFICATE OF LIABILITY INSURANCE DATE / s°'"'YY) PRODUCER HRH of Colorado 720 S. Colorado Blvd Ste B00-N P.O. Box 469025 Denver, CO 80246-9025 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 # INSURED A-1 Chipseal Company 1935 Snowy Owl Drive Broomfield, CO 80020 INSURER A: Mountain States Insurance Grp 5900 INSURERB: Pinnacol Assurance 10750 INSURER C: INSURER D: 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 SHOWAI MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER DATEYMhW EFFECTIVE ELICY TE MM/DDrVY EXPIRATION LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR CPP0106662 10/01/05 10/01/06 EACH OCCURRENCE $1000000 DAMAGE TO REffijNTED S1OO 000 MED EXP (Any one person) $10 000 PERSONAL 3 ADV INJURY $1 000 000 GENERAL AGGREGATE s2,000,000 GEN,L AGGREGATE LIMIT APPLIES PER: POLICY X PRO• El LOC PRODUCTS -COMWOP AGG $2000000 A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-ONMED AUTOS BAP0106662 CITY 10/01/05 10/01/06 LINS COMBINED SINGLE LIMIT (Eaaocident) $1,000,000 X AY 1 ZOO OF FORT CO BODILY INJURY (Per Person) $ X BODILY INJURY (Per accident) $ X PROPERTY DAMAGEDIC (Per acddxn) $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHERTHAN EA ACC AUTO ONLY: AGG $ $ A EXCESSIUMBRELLA LIABILITY TOCCUR CLAIMS MADE DEDUCTIBLE X RETENTION $ 10000 UMB0106662 10/01/05 10/01/06 EACH OCCURRENCE $5 000 000 AGGREGATE $5 000 000 $ $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? It yes describe under SPECIAL PROVISIONS bebw 4055760 Owners/Officers Included 10/01/05 10/01/06 TH X TORY WC LIMIT ER E.L. EACH ACCIDENT $500 000 E.L. DISEASE - EA EMPLOYEE s500000 E.L. DISEASE - POLICY LIMIT $500 000 OTHER DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES! EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Project Description: 5967 Asphalt Slurry Seal Project 2006 The following are Additional Insureds as respects General Liability and Umbrella Liability (Following Form) only if required by written contract (See Attached Descriptions) City of Fort Collins 300 La Porte Fort Collins, CO 80522 LD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL _30* DAYS WRITTEN :E TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL iE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR AUTHORIZED ACUKU Z5 (zUU11UV) 1 of 3 #S290444/M266147 LZM o ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or after the coverage afforded by the policies listed thereon. ACORD 25S (2001108) 2 of 3 #S290444/M266147 DESCRIPTIONS, (Continued from Page 1) and coverage applies only as respects work performed by the Insured for the Additional Insureds. All coverage terms, conditions and exclusions of the policy apply. The following are Additional Insureds on the Automobile Liability only to the extent they meet the definition of an insured in the policy, which provides in pertinent part that an insured includes anyone liable for the conduct of another insured but only to the extent of that liability. All coverage terms, conditions and exclusions of the policy apply. Consult the policy to determine the extent of coverage, if any. Additional Insureds: City of Fort Collins The General Liability coverage is Primary per the policy terms & conditions only if required by written contract. The Workers' Compensation policy includes a Waiver of Subrogation in favor of the Additional Insureds only if required by written contract. The Additional Insured endorsement which is referenced above under "Type of Insurance -General Liability" is attached. " The following cancellation conditions always apply: -10 days for non-payment of premium - If policy shown,10 days for Workers' Compensation for fraud; material misrepresentation; non-payment of premium; other reasons approved by the Commissioner of Insurance AMS 25.3 (2001108) 3 of 3 #S290444/M266147