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HomeMy WebLinkAbout180828 COLORADO BORING COMPANY - INSURANCE CERTIFICATE (2)OP ID JL DATE (MW DDI1rY-YY) ACORD_ CERTIFICATE OF LIABILITY INSURANCE COBOR-1 1 09 11 08 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYAND 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 : 910-635-9400 Fax: 970-635-9401 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Auto —Owners Insurance Co_ 18988 INSURER B: Pinnacol Assurance Colorado Boring, I.LC Attn: Jon Jacobs INSURER G: 3813 Canal Drive INSURER D: Fort Collins CO 80524 INSURER E: COVERAGES I HE PU-IUIts Ur lrAbUKAN;,t LIS I t0 tit LUVV NAVt Lit CN IDDUCV I:J I nC INJUKCV VANMVAOU Vc rVK rn=ruLI T-cm— I{VVIUII I=u. ry I-1 n-1 -- ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN THE INSU?AN'CE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE 1-121AITS SHOVVN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I LTR D NSRd TYPE OF INSURANCE POLICY NUMBER POLIC EFFECTI DATE MMIDD/YY PO C EXPIRA T ION DATE MM/OOIYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X OCMN•ERCIALGENEP.ALLIABILITY 74731383 08/01/08 08/01/09 6? �P PREMISES (Eaoccurence) S 50,000 CL.AINIS MADE 1 -- I OCCUR MEO EXP (Ary one person) s5,000 PERSONAL B AOV INJURY j S 1,000,000 GENERAL AGGREGATE S 2, 00O , 00O PROCUCTS - COMPiOPAGG $ 2,000,000 GENL AGGREGATE L MIT APPLIES PER: I POLICY PROJECT LOC , AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 A X ANYA.UTC 47731383 08/01/08 08/Ol/09 (EaacdCent) $ ALL ONAINED AUTOS BODILY INJURY SCHEDULED AUTOS (For person) S HIRED AUTO BODILY INJURY NON -OWNED AUTOS (Per accident; S. PROPERTY DAMAGE (Per accidenti GARAGE LIABILITY AJTC ONLY - EA ACCICENT $ OTHER THAN EA ACC $ ANYAUTC I ALTO ONLY: AGG S EXCESS/UMBRELLA LIABILJTY EACH 0CCLRRENCE S 5, O00 , 00O A X J OCCUR CLAIMSMADE BINDER 08/01/08 08/01/09 AGGREGATE_ IS5,000,000 S $ " DEDUCTISLE $ F. RETENTION $ 10 000 WORKERS COMPENSATION AND X A TORY I,AT S X ER B EMPLOYERS' LIABILITY 4021687 D8/01/06 08/01/09 E.L. EACH ACCIDENT 51,000,000 ANY PROPRI=TOR/PARTNER/EXECUTIVE OFFICERIPAEMBEREXC_VDED? BLANKET WAIVER OF SUBROGA OS/Ol/OB O8/Di/O9 E._.DISEASE -EA EMPLOYE 31,000,000 I! yes, desulbe under SPECIAL PROVIS ONS below - E.L. DISEASE - POLICY LIMIT $ 1 000 , 000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS [VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS The City of Fort Collins and CDOT are named as additional insured in regards to the general liability policy. CERTIFICATE HOLDER CANCELLATION City of Fort Collins Purchasing 281 North College Ave Fort Collins CO 805220580 FORT-01 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIC 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 SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR REPRESENTATIVES. ACORD 25 (2001108) © ACORD CORPORATION 191 Z'd 99 L l-M-0L6 ueweea_� wiy{ eg V60 60 90 Cled OP ID JL DA7E(MMIDDfYYYY) ACORD CERTIFICATE OF LIABILITY INSURANCE coaoR-1 1 09 11 as 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 Tho son Pk ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Johnstown CO 80534 Phone:970-635-9400 Fax:970-635-9401 INSURED Colorado Boring, LLC Attn: Jon Jacobs 3813 Canal Drive Fort Collins CO 80524 COVERAGES INSURERS AFFORDING COVERAGE NAIC # INSURER A: Auto -Owners Insurance Co. 18988 INSURER 8: Pinnacol Assurance INSURER C: INSURER D: INSURER E: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHS-ANDING ANY REQUIREMENT. TERNI OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH -HIS CERTIFICATE MAY SE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY TF:E POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMIT SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN LTRINSRE TYPE OF INSURANCE POLICY NUMBER POLICY FF IVE DATE NIMIDDlYY -p-c-LTc-V-EX-p1IUTIbN DATE MMIDDiYY -- LIMITS A GENERAL LIABI_ITY X COMMERCIAL GENEP..ALLIABILITY CLAIMS MADE � OCCUR 74731383 0$/01/08 08/01/09 EACH OCCURRENCE 'GTGE-TOLE. PREMISES (Ea oocurence) MED ENP (Any ons person) S 1,000,000 S50,000 S 5 , 000 PERSONAL & ADV INJJRY S 1 , 000 , 000 GENERALAGGREGATE s2,000,000 , GEN I- AGGREGATE LIMIT APPLIES PER: 17 POLICY JECPROT LOC PRODUCTS - COMPIOP AGG ..4 2 , 0 0 0, 00 0 A AUTOMOBILE LIABILITY ANY AUTO ALL ObVNED AUTOS SC)-EDULED AUTOS HIRED AUTOS NOV-CLVNEO AUTOS 47731383 i 08/01/08 08/01/09 ident)ED LE LIMIT IEa accidenry (Ea $1 000 000 r � X BODILY IN„URY (Per person) $ BODILY IN-URY (Per accident ) S S PROPERTY DAMAGE (Per accident) GARAGE LIABILITY ANY AUTO I AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: AGG S S A EXCESS/UMBRELLA LIABILITY X OCCUR CLAIMS MADE DEDUCTIELE X RETENTIO`I S10,000 BINDER 08/01/08 08/01/09 EACH OCCURRENCE I $ 5,000,000 AGGREGATE $5,000,000 S $ S B WORKERS COMPENSATION AND EMPLOYERS*LIABIUTY ANY PROPRIETORIPA.RTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below 4021687 BLANKET WSVER OF SUBROGA 08/01/08 08/01/08 i X I TORY IIMITS X ER 08/01/09 I E.L. EACH ACCIDENT 08/01/09 E.L. DISEASE- EA EMPLOYEE E.L. DISEASE - POLICY LIMIT S 1,000,000 i 1,a0Q,000 $ 1 , a0 a , OO a OTHER U CSGRIP I IUIV UY UF'6 RA Ii:]N5 I LUGA I IUNU I VGI tMIUL" ACLU510N5DUU At11Y ENDORSEMEN L I SPECIAL PRUVRRUM5 Certificate holder is named as additional insured in regards to the general liability. CERTIFICATE HOLDER CANCELLATION City of Fort Collins Building and Zoning 281 North College Ave Fort Collins CO 805220580 FORT- O1 SHOULD ANY CIF 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 SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. ACORD 25 (2001108) �'d 89 � b-M-0L6 ©ACORD CORPORATION 198E ueweead wiy{ OVV60 60 90 gezj