HomeMy WebLinkAboutROBERTS - INSURANCE CERTIFICATESep-17-08 01:53pm From—Brown&Brown
9704844165 T-676 P 001/001 F-978
CORD ROHER-7 CERTIFICATE OF LIABILITY INSURANCE OPID D DATIs( 09 17 Y /
.a17 08
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORM! TION
Brown & Brown Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFIC14-1E
125 S Howes, 5th Floor HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTENT: -OR
P O BOX 2226 ALTER THE COVERAGE AFFORDED BY THE POLICIES BI:LOW.
Fort Collins CO 80522-2226
Phone:970-482-7747 FaX:970-484-4165 INSURERS AFFORDING COVERAGE N41C#
INSURED INSURER A: Mountain States Mutual 14648
INSURER B: Plnnac Ol Assurance 11190
Roberts Excavation Corporation FINSUR�ERCAttn: Gerald Roberta1801 1st street SUBerthoud CO 80513
SURER E:
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.
IN POLICY NUMBER DATE MMIDDMI PDAE MMIDD/YY LIMITS
LTR NSR TYPE OF INSURANCE
GENERAL LIABILITY
EACH OCCURRENCE
S,L{00000
Eaoccarance)
A
X COMMERCIAL GENERAL LIABILITY
CPP0114757
04/15/08
04/15/09
s 1L-0OOO
_PREMISES
MEO EXP (My one person)
CLAIMS MADE X� OCCUR
$ 11000
PERSONAL S ADV INJURY
51,-00000
X
Employee Benefits
GENERAL AGGREGATE _
$2{:0000O
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMPIOP AGG
S2.'000O0
POLICY X JET LOC
AUTOMOBILE
LIABILF
COMBINED SINGLE LIMIT
51:100000_
A
ANY AUTO
BAP0114757
04/15/08
04/15/09
(Ea..idsnt)_T
X
BODILY INJURY
ALL OWNED AUTOS
5
-
(Per parson)
SCHEDULED AUTOS
HIRED AUTOS
BODILY INJURY
y
(Per smaenI)
MON•OWNED AUTOS
.—.
PROPERTY DAMAGE
S
(Per amiaent7
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
S
OTHERTHAN EAACC
ANY AUTO
S _
AUTO ONLY: AGG
$
EXCESSIUMBRELLALU161LITY
EACH OCCURRENCE
$ 1000000
AGGREGATE
S1_000000
A
X OCCUR CLAIMSMADE
UMB0114757
04/15/08
04/15/09
S
§
DEDUCTIBLE
._
_....
5 ,
X RETENTION S10000
WORKERS COMPENSATION AND
TORY LIMBS X ER
_ _
E.L. EACHAcc10EN'r
H
EMPLOYERS' LIABILITY
3241433
06/01/08
06/01/09
$l]00000
ANY PROPRIETOR/ R/EXECUTIVE
EXCLUDED?
OFFICER/MEMBER E%CWDE09
BLET WAIVER OF SUB
e.L. DISEASE. EA EMPLOYEE
S 1 )00000
EL DISEASE - POLICY LIMIT
S1)00000
Ryes, Cesc,.baanber
SPECIAL PROVISIONS below
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
FaX,". 221-6707 / 532-1442
ra:.,W I +AT IM Unl nco CANUELLA 11UN
city of Fort Collins
Purchasing
215 H. mason St.
Fort Collins CO SOS21
CITYPIO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEF-: RE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 _ DAY5 WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILUJ E TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES. _
AtFH asu REPRESENTATIPE`1 1