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Home My WebLink AboutDEC CONRETE - INSURANCE CERTIFICATECERTIFICATE HOLDER COPY CITY OF FT COLLINS 281 NORTH COLLEGE FORT COLLINS CO 80525 POLICY NUMBER: 4080273 BUSINESS LOCATION: DEC CONCRETE LLC CLASSIFICATION OF OPERATION CLASS DESCRIPTION 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, certian 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 alter the coverage afforded by the policies listed thereon. COVERAGE COVERAGE RATING EFFECTIVE EXPIRES TYPE 522105 CONCRETE-FLATWORK & DRIVERS 05/01/2006 05/01/2007 EM ACORD,. CERTIFICATE OF LIABILITY INSURANCE MM DATE (6/13/006 PRODUCER Pinnacol Assurance 7501 E Lowry Blvd DENVER CO 80230-7006 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 DEC CONCRETE LLC 420 HUNTINGTON HILLS DRIVE FORT COLLINS CO 80525 INSURERA Pinnacol Assurance 41190 INSURER B. INSURER 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR ADD INSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE(MM/DD/YYYY) POLICY EXPIRATION DATE(MM/DD/YYYY) LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Es occurrence) MED EXP (A" one person) PERSONAL A ADV INJURY GEN'L AGGREGATE LIMIT APPLIERS PER: POLICY PROJECT LOG GENERAL AGGREGATE PRODUCTS - COMP/OP AGG AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea acckeM) BODILY INJURY (Per person) BODILY I W URY (Per accident) PROPERTY DAMAGE (Per accitleM) GARAGE LIABILITY ANYAUTO AUTO ONLY - EA ACCIDENT OTHERTHAN EA ACC AUTO ONLY'. AGG EXCESSRIMBRELLA LIABILITY OCCUR CLAIMS MADE DEDUCTIBLE RETENTION S EACH OCCURRENCE AGGREGATE A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR,PARTNER/EXECUTIVE OFFICER,MEMBER EXCLUDED? If yes, please tlescribe untler SPECIAL PROVISIONS below 4080273 05/01/2006 05/01/2007 X WC STATU. OTHER TORY LIMITS E.L. EACH ACCIDENT a� $100000 E.L. DISEASE - EA EMPLOYEE $100,000 E.L. DISEASE - POLICY LIMIT $500,000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS PROJECT # 7263- HOMEWOOD SUITES BY HILTON 1521 OAKRIDGE DRIVE FT COLLINS COLORADO 80525 THE LAW COMPANY INC 345 RIVERVIEW DRIVE STE 300 WICHITA KANSAS 67203 SEE BACK OF CERTIFICATE FOR CLASS COVERAGE AND OWNERSHIP COVERAGE DETAIL r } 200ai+JUN i�otiM s��4_e CERTIFICATE HOLDER CANCELLATION 916974 CITY OF FT COLLINS 281 NORTH COLLEGE FORT COLLINS CO 80525 ACORD 28 2001/08 SHOULD ANY OF THEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 0 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Rodney Postillion Underwriter ACORD CORPORATION 1988 J FEARSS CSR Support 08/13/00 W 42:58 4080273 Updated 12/15/199612:W W UWI35 CERTIFICATE HOLDER COPY CITY OF FT COLLINS 281 NORTH COLLEGE FORT COLLINS CO 80525 POLICY NUMBER: 4080273 BUSINESS LOCATION: DEC CONCRETE LLC CLASSIFICATION OF OPERATION CLASS DESCRIPTION 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, certian 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 alter the coverage afforded by the policies listed thereon. COVERAGE COVERAGE RATING EFFECTIVE EXPIRES TYPE 522105 CONCRETE-FLATWORK & DRIVERS 05/01/2006 05/01/2007 EM