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108423 VOGEL CONCRETE INC - INSURANCE CERTIFICATE
L. ® DATE (MM/DD/YYYY)....__...._. �Rv CERTIFICATE OF LIABILITY INSURANCE OP ID VOGELK-Hl 01/05/10 ODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE LBN Insurance"Agcy-Johnstown HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 4848 Thompson Pkwy, Ste 200 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOV Johnstown CO 80534 Phone:970-635-9400 Fax:970-635-9401 INSURED VogelConcrete, Inc. 6330 S College Ave Fort Collins CO 80525-4044 CnVFRAnFR INSURERS AFFORDING COVERAGE NAIC # INSURERA: Pinnacol Assurance 41190 INSURER B: Auto —Owners Insurance Co. 18988 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. 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. INS L T R NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM/DD/YYYY POLICY EXPIRATION DATE MM/DD/YYYY LIMITS B GENERAL LIABILITY - X COMMERCIAL GENERAL LIABILITY CLAIMS MADE I —XI OCCUR X bink addl ins 74006127 01/17/10 01/17/11 EACH OCCURRENCE $ 1000000 PREMISES(E.occurence) $ 300000 MED EXP (Any one person) $ 10000 PERSONAL & ADV INJURY $ 1000000 GENERAL AGGREGATE $ 2000000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PRO LOC JECT PRODUCTS - COMP/OPAGG $ 2000000 B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIREDAUTOS NON -OWNED AUTOS 4709905200 01/17/10 01/17/11 COMBINED SINGLE LIMIT (Ea accident) $ 1000000 X BODILY INJURY (Per person) $ X BODILY INJURY (Per accident) $ X PROPERTY DAMAGE (Per accident) - $ GARAGE LIABILITY ANY AUTO N/A AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: AGG $ $ EXCESS / UMBRELLA LIABILITY OCCUR CLAIMS MADE DEDUCTIBLE RETENTION $ N/A EACH OCCURRENCE $ AGGREGATE $ $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY OFFICER/MEMBER EXCLUDEPROPRIETOR/PARTNER/E ECUTIVq-----I (Mandatary-In-NI-1). _ _ If yes, describe under SPECIAL PROVISIONS below 4102132 _ 07/01/09 _ 07/01/10 X TORY LIMITS ER E.L. EACH ACCIDENT $ 100000 E.L. DISEASE- EA EMPLOYEE $ E.L. DISEASE- POLICY LIMIT 1 $ 500000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS I£ required by written contract or written agreement, certificate holder is included as additional insured for ongoing operations under General Liability. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION FTCOLLI 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 City of Ft. Collins IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Purchasing Division REPRESENTATIVES. 215 Mason Street P.O. BOX 580 AUTyQRIZEDR _ EPRESENTATIVE Ft. Collins CO 80522-0580 ACORD 25 (2009/01) ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD IMPORTANT the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement i this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may ;quire an endorsement. A statement on this certificate does not confer rights to the certificate 3Ider in lieu of such endorsement(s). DISCLAIMER This Certificate of Insurance 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 (2009/01)