HomeMy WebLinkAboutKIEFER CONCRETE - INSURANCE CERTIFICATE (2)JUL 22 2004 14:16 FR TO 2216707 P.01/01
AMR-D. CERTIFICATE OF LIABILITY INSURANCEESOPIDE 1 DATE(MMIDDAN)
07/22/O4
PRODUCER - THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Brown & Brown Inc - Ft Collins ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
125 8 Howes, 5th Floor HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P 0 Box 2226 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Fort Collins CO 80522-2226 INSURERS AFFORDING COVERAGE
Phone:970-482-7747 FaxL970-484-4165
INSURERA:
INSURER B:
Kiefer Concrata Inc INSURER C:
360 Linden NSURER D'.
Ft Collins CO 80524
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 AMTH 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 CLAWS. T
MR � TYPE OFINSURANCE POLICY NUMBER OATCM ILl DATE MMIDDM/ N UNITS
II
A I
—GENERAL LABILITY
XlCOMMERCIAL GENERAL LIABILITY
CLAIMS MADE CI OCCUR
CPP0074434-03
01/01/04
01/01/05
EACH OCCURRENCE
S 1000000
FIRE DAMAGE(Any ono fine)
$100000
MED EXP (Any one parson)
$5000
PERSONAL AADV INJURY
$ 1000000
J
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY X jPrR LOC
GENERAL AGGREGATE
S 2000000 ^
PRODUCTS -COMPIOP AGO
S2000000
_
A
AUTOMOBILE
X
...
LIABILITY
ANY AUTO
ALL OVO4ED AUTOS
SCHEDULEDAUrOS
HIRED AUTOS
IWON -OWNED AUTOS
1 _ .-.-. ....
BAP0074434-03
01/01/04
01/01/05
COMBINED SINGLE LIMIT
(Ea aceidOM)
S1000000
BODILY INJURY
(Per parson)
$
BODILY INJURY
(Par awldent)
S
-
PROPERTY DAMAGE
(Per accident)
:
GARAOE LIABILITY
ANY AUTO
AUTO ONLY -EA ACCIDENT
S
OTHER THAN �IACC
AUTO ONLY: AGG
$
S
A
EXCESS LIABILITY
X OCCUR CLAIMSMADE
_ DEDUCTIBLE
X RETENTION $ 10000
UMB0074434-03
01/01/04
01/01/05
EACH OCCURRENCE
S 4000000
AGGREGATE
s 4000000
s _ _
$ LL
$
1 WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
B i
3068852
01/01/04
01/01/05
WC BTA[Ua
X I TORY LIMITS F ER
E.L. EACH ACCIDENT
IS500000
EL DISEASE - EA EMPLOYEE
5500000
E.L. DISEASE -POLICY LIMIT
I S500000
OTHER
DESCRIPTION OF OAERATIONSILOCATIONSNEHICLESrtKCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
Fax#221-6707
CERTIFICATE HOLDER IN I ADDITIOtM INSURED; INSURER LETTER: _ CANCELLATION
C,ITYFTrJ' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MALL ,.U— DAYS WRITTEN
City Of Fort Collins NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUY FAILURE TO DO 50$NALL
Purchasing IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR
P O BOX 580
Fort Collins CO 80522 REPRESENTATIVES.
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