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HomeMy WebLinkAboutCONCRETE STRUCTURES INC - INSURANCE CERTIFICATE (2)ACORDTM CERTIFICATE OF LIABILITY INSURANCE ' 0DATE 3126/10D PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Willis of Colorado, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 720 South Colorado Boulevard HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Suite 60ON Denver, CO 80246 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Valley Forge Insurance Company 20508 Concrete Structures, Inc. INSURER B: American Casualty Company of Reading 20427 Long Hilltop Road INSURER C: Pinnacol Assurance 41190 Longmont, CO 80504 INSURER D: Travelers Property Casualty Company 36161 INSURER E: Transportation Insurance Company 20494 COVFRAGFS 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. " INSR LTR ADD'L ADD' INSRE TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM/DD/YY POLICY EXPIRATION DATE MM/DD/YY LIMITS A GENERAL LIABILITY 2047965998 11/30/09 11/30/10 EACH OCCURRENCE $1 000 000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENT06cED Fre^ce) $300OOO " CLAIMS MADE F_x1 OCCUR MED EXP (Any one person) $rj 000 PERSONAL & ADV INJURY $1 000 000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG s2,000,000 POLICY X PRO- JECT X LOC E AUTOMOBILE LIABILITY X ANY AUTO 2047965984 11/30/09 11/30/10 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS X HIRED AUTOS X NON -OWNED AUTOS Hired PhyS Dmg Limit$50,000 BODILY INJURY (Per accident) $ X Comp $1,000 Ded PROPERTY DAMAGE (Per accident) $ X I Coll $1,000 Ded GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY: AGG B EXCESS/UMBRELLA LIABILITY 204966004 11/30/09 11/30/10 EACH OCCURRENCE $4000000 X1 OCCUR CLAIMS MADE AGGREGATE s4,000,000 $ $ DEDUCTIBLE $ X RETENTION $ 10000 C WORKERS COMPENSATION AND 4103112 04/01/10 04/01/11 X WC LIMITTATUJ 0FR EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $1 OO,000 E.L. DISEASE - EA EMPLOYEE $100,000 OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below _ E.L. DISEASE - POLICY LIMIT s500,000 D OTHER Owned QT6606045BO68TIL09 11/30/09 11/30/10 $155,000 Total Limit Leased/Rented $125,000 Blanket Limit Contractors Equip $1,000 Deductible DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Project Description: 7081 Bridge Replacement - Whitcomb and Magnolia This Certificate of Insurance represents coverage currently in effect and may or may not be in compliance with any written contract. (See Attached Descriptions) City of Fort Collins P. O. Box 580 Fort Collins, CO 80522 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL *so 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 ACORD 25 (2001/08) 1 of 3 #M667485 8VMAN © ACORD CORPORATION 1988