HomeMy WebLinkAboutROBERTS EXCAVATION CORPORATION - INSURANCE CERTIFICATE (2)OP ID D DATE (MMIDD/YYYY)
ACORD CERTIFICATE OF LIABILITY INSURANCE ROBER-7 04 23 10
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: 970-484-4165 INSURERS AFFORDING COVERAGE NAIC #
INSURED INSURERA: Mountain States Mutual 14648
INSURERB: Pinnacol Assurance Company 41190
Roberts Excavation Corporation
Attn :r . , Gerald Roberts INSURER C:
1801 1st 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 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.
NSR
LTR NSR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE MM/DD/YY
POLICY EXPIRATION
DATE MM/DD/YY
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$ 1000000
A
X COMMERCIAL GENERAL LIABILITY
CPP011475703
04/01/10
04/01/11
PREMISES (Ea ocourence)
$ 100000
CLAIMS MADE X� OCCUR
MED EXP (Any one person)
$ 10000
PERSONAL BADVINJURY
$ 1000000
X
Employee Benefits
GENERAL AGGREGATE
$ 2000000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
s2000000
POLICY X PRCO� LOC
A
AUTOMOBILE
LIABILITY
ANY AUTO
BAP011475703
04/01/10
04/01/11
COMBINED SINGLE LIMIT
(Ea accident)
$ 1000000
X
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY
(Per accident)
$
HIRED AUTOS
NON -OWNED AUTOS
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
$
AUTO ONLY: AGG
EXCESS/UMBRELLA LIABILITY
EACH OCCURRENCE
$ 1000000
A
X I OCCUR CLAIMSMADE
UMB011475703
04/01/10
04/01/11
AGGREGATE
$ 1000000
$
DEDUCTIBLE
$
X RETENTION $ O
WORKERS COMPENSATION AND
WC STATU-
X TORY LIMITS ER
B
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
3241433
06/01/09
06/01/10
E.L. EACH ACCIDENT
$ 1000000
E.L. DISEASE - EA EMPLOYE
$ 1000000
OFFICER/MEMBEREXCLUDED?
If es, describe under
SPECIAL PROVISIONS below
E.L. DISEASE- POLICY LIMIT
$ 1000000
OTHER
A
Leased or Rented
CPP011475703
04/01/10
04/01/11
Lsd/Rnted $400,000
,Equipment
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Fax# 221-6707 / 532-1442
CERTIFICATE HOLDER CANCELLATION
CITYF10 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN
City of Fort Collins NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
Purchasing IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
215 N. Mason St.
Fort Collins CO 80521 REPRESENTATIVES.
PRESEN'fdTIVE1
ACORD 2512001/0RI Wkrniin CORPORATION 198E