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Home My WebLink About407669 C AND J TRENCHING - INSURANCE CERTIFICATEFax Server 9/4/2008 3 21 35 PM PAGE 2/004 Fax Server (:I.PDHt A1'tAd C.ITRP ACORD- CERTIFICATE OF LIABILITY °WTI INSURANCE 9/410`8 PRODUCER THIS CERTIFICA7E IS ISSUED AS A MATTER OF INFORMATION Flood 3 Peterson Insurance Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 4821 Wheaton Drive HOLDER THIS CERnFICATE DOES NOT AMEND EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW P 0 Box 270370 Fort Collins CO 80527 INSURERS AFFORDING COVERAGE NAIC a NSIRFD INSURER A. United Fire & Cas C 6 J Trenching and Construction Inc INSURER a Plnnecol Assurance 421 Bobcat Drive Milliken CO 811543 INSURER ERE! 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 SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS In TYPE OF INSURANCE POLICY NUMBER " Y PRATE IXPPAr WITS A GENERAL LIABILITY 60080110 07/18/08 07/18100 EACH OCCURRENCE f1 000 X COMMERGALGENERALUASKUTY PREMIETORENTED $100,000 CLAIMS MADE OCCUR MED EXP (Any ane PNeee) $5 000 PERSONALaADVINJURY $1000000 X PDDed250 GENERAL AGGREGATE f2 000 000 GENL AGGREGATE LIMIT APPUESPER PRODUCTS COMPA]P AGG $2000000 PGJGY PR4 LOC A AUTOMOBILELMBMTY ANYAUTO BOO130110 07118108 07/1BM COMBINED SINGLE UNIT (re=) $1000000 BODILY INJURY (P Pp ) f ALL OWNEO AUTOS SCHEDULED AUTOS X X BODILY INJURY pgrs ffl) f HIREDAUTOS NON-O ED AUTOS X PROPERTY DAMAGE (Per eWtleM) S GARAGE LMBERY AUTOONLY EAACCIOENT $ OTHERTHAN EA ADD S ANY AUTO S AIlTOONLY AGO IXCESBAIMBRELLALAS0. EACH OCCURRENCE f AGGREGLTE S OCCUR CLNMSMAOE S f DEDUCTIBLE S RETENTION $ B WORKERS COMPENSATION AND 4009105 01/01/08 01/01109 X WCSTATU- TSI DTV4 EY PRO R I TOR(PALIABILIT'/ ANY PROPRIETIXiIPMTNEWFJECUTNE EL EACH ACCIDENT $100 000 EL DISEASE EA EMPLOYEE$100000 OFFICEVMEMBER EXCLUDED? M uMs ELDISEASE POIJCY LIMIT $500,000 ;9yee PR 9FEGAL PROVISIONS beIPx OTHER OESCRIPTION OF OPERATIM I LOCATONS I YENICLFA I IXCLU&ONS ADDED BY ENDORSEMENT I SPECML PROV MNINS Re Snow Removal Attn John Stevens City of Fort Collins its officers agents and employees are named as additional Insured but only as rsspocbNabiNiy arising out of ongoing operalbns of the named Insured (Excluding Workers Compensation) (See Attached Descriptions) City of Fort Collins P O Box 580 Fort Collins CO 80522 1 Of3 M424718/M42038B SHOULD ANYOF THE ABOVE DESCRIBED POLICES M CANCELLED BEFORE THE EJMIRATDN DATETHESEOFTIENSUINGSSURERWIUEJSEAWMTOWR --3a_ DAYSWRRTEN NOTICETOTNECSmFIwTE1gLDERNAEEDTOTHEU" BUTFAILURETODOSOSHAU MP NOOSUGATIONORLMBLDYOFANYNSDUPONTHENWUI%ITSAGENTSOR AUTHORIZEDREPRESERT TRIM /oAsat + '74AltonA ZaJ{yl +R.AJKR I jive_ 41 s a ACORD CORPORATIO Fax Server IMPORTANT If the certificate holder is an ADDITIONAL INSURED the poticy(es) 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 ACORD 25-8 (2o01roe) 2 of 8 f1S42471161fiA42a9B8 RF-ScRIPTIONS (Conlinuecl from Page 1) Fax #MI 6707 per fax from Use cc Fax #653-0018 to Insured 3 of 3