HomeMy WebLinkAboutVOGEL CONCRETE - INSURANCE CERTIFICATE (3)_ACORD. CERTIFICATE OF LIABILITY INSURANCE OPID KH DATE (M3.5 VY)
VOGEL-1 07 15 08
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
LBN Insurance Agency HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
4848 Thompson Pkwy ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Johnstown CO 80534
Phone: 970-635-9400 Fax: 970-635-9401 INSURERS AFFORDING COVERAGE NAIC #
INSURED ___. ......_..... -_
INSURER A: P1nnaC01 ASSllranCE!
INSURER B.
Vogel Concrete, Inc. INSURER C:
6330 S College Ave INSURER D'.
Fort Collins CO 80525-4044---------
Lsnja:faaW,
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.
FIY EFFECTIVE PO ION
LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MMIDDM' DATE MMIOD/YY LIMITS
GENERAL
LIABILITY
EACH OCCURRENCE
$
COMMERCIAL GENERAL LIABILITY
N A
/
-DAMAGES( RENTED
PREMISES (Ea NTEDnce)
§
CLAIMS MADE n l OCCUR
MED EXP (Any one person)
$
PERSONAL &ADV INJURY
S
GENERAL AGGREGATE
5
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS COMP/OP AGG
$
POLICY HE LOC
ECT
AUTOMOBILE
---,
LIABILITY
COMBINED SINGLE LIMIT
ANY AUTO
N/A
/
(Ea accident)
$
- -
ALL OWNED AUTOS
BODILY
B
SCHEDULED AUTOS
(Per
(Per person)
persoru,
$
HIRED AUTOS
BODILY INJURY
NON -OWNED AUTOS
(Pet accident)
$
PROPERTY DAMAGE
$
(Per accident)
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
ANY AUTO
N/A
EA ACC
OTHER THAN
$
---
AUTO ONLY: AGG
$
EXCESS/UMBRELLA LIABILITY
EACH OCCURRENCE
$
7 OCCUR CLAIMS MADE
N/A
AGGREGATE
$
5
DEDUCTIBLE
S
RETENTION $
§
WORKERS COMPENSATION AND
%{ I TO RYLI MITS I I ER
A
EMPLOYERS' LIABILITY
4102132
07/01/08
07/01/09
EL EACH ACCIDENT
'--
$100000
ANY PROPRIETORIPARTNERIEXECUTIVE
OFFICER/MEMBER EXCLUDED?
E.L. DISEASE - EA EMPLOYEE
$ 100000
If yes, describe under
E.L. DISEASE -POLICY LIMIT
--___ -----
$5000D0
SPECIAL PROVISIONS below
OTHER
N/A
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
CEK I IFICA It HOLIJEK CANCELLATION
FTCOLLI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO 50 SHALL
City OFt.B.
O-Neill Collins
J B
Attn: James B. O'NIMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
P.O. BOX 580 REPRESENTATIVES.
Ft. Collins, CO 80522-0580 AUT '*AEgRESEftATIJ
ACORD 25 (2001108) IS, AC(1RF1 Cl1RPORATI(1N IOAR
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 alter the coverage afforded by the policies listed thereon.