HomeMy WebLinkAboutROBERTS EXCAVATION CORPORATION - INSURANCE CERTIFICATE (3)acORv,. CERTIFICATE OF LIABILITY INSURANCE OF ID D
DATE (MMIDD VVVV)
ROBER-7
04/15/09
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Brown & Brown Inc
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
125 S 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
Phone:970-.482-7747 Fax:970-484-41.65
INSURERS AFFORDING COVERAGE
NAIC#
_.
INSURED
INSURER A: Mountain States Mutual
14648
_ _
INSURER B Pinnacol Assurance Company
41190
Roberts Excavation Corporation
--
_--
Attn: Gerald Roberts
INSURERc
1801 lst Street
( INSURERD
Berthoud CO 80513
-
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 MAYBE 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.
INSR'gqDD'LJ POLICY EFFECTIVE- POLICY EXPIRATION - _-- - -- - - -
LTR 1NSR POLICY NUMBER TYPE OF INSURANCE I DATE MM/DD/YY DATE MMIDD/YY LIMITS
A
GENERAL LIABILITY
X COMMERCIALDAMAGE
GENERAL
CPP011475702
04/15/09 04/15/10
EACH OCCURRENCE
TO RENTED -"
PREMISES
I $ SOOOOOO
IlI $ 100000
CLAIMS MADE X, I. OCCUR
(Eaoccurence)
MED EXP(Any one person)_..
$ 10000
PERSONAL &ADV INJURY
$ 1000000
X iEmployee Benefits
GENERAL AGGREGATE
$ 2000000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS COMP/OP AGO
$2000000
POLICY iX JECT I LOG
A
AUTOMOBILE
._..
X
LIABILITY
ANY AUTO
BAP011475702
04/15/09 04/15/10
COMBINED SINGLE LIMIT
(Ed accldeJ
$ SOOOOOO
ALL OWNED AUTOS
I
BODILY INJURY
$
SCHEDULED AUTOS
(Per person)
HIRED AUTOS
BODILY INJURY
$
NON -OWNED AUTOS
(Per accident)
PROPERTY DAMAGE
$
(Per accident)
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
ANY AUTO
(
OTHER THAN EA ACC
$
AUTO ONLY: AGG
$
EXCESS/UMBRELLA LIABILITY
j
EACH OCCURRENCE
$10001000
A
X OCCUR-_� cLAIMSMADE
i UMB011475702
04/15/09 04/15/10
AGGREGATE
$ 1000000
DEDUCTIBLE
$
_.I
X I RETENTION $10000
!
WORKERS COMPENSATION AND
ST
X TORV LIMITS ER
B
EMPLOYERS' LIABILITY
1 3241433
06/01/08 06/01/09
EEACH ACCIDENT
L
-_-
$ 1000000
ANY PROPRIETOR
--- --
-.
EXCLUDED?
OFFICERMEMBER EEXCLUDED?
describe
!
E.L.DISEASE EA EMPLOYEE
$ 1000000
Yes antlerVISIONS below
SPEC
S IAL PROVISIONS
E.L. DISEASE -POLICY LIMIT
$ 1000000
OTHER
I
�
I
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Fax# 221-6707 / 532-1442
CERTIFICATE HOLDER CANCELLATION
CITYFI O
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIOls
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN
City of Fort Collins
Purchasing
215 14. Mason St.
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
Fort Collins CO 80521
REPRESENTATIVES.
AtlFN�r21ZED REPRESE
ACORD 26 (2001/08) `9 ACORD CORPORATION 1988