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HomeMy WebLinkAboutVOGEL CONCRETE INC - INSURANCE CERTIFICATE® wCERTIFICATE OF LIABILITY INSURANCE OP'ID"KH DATE (MM/DD/YYYY) ...... -' 06/11/10 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER LBN Insurance Agcy-Johnstown 4848 Thompson Pkwy, Ste 200 Johnstown CO 80534 Phone:970-635-9400 Fax:970-635-9401 NAME: PHONE AX A/C, No, Ext : (A/C, No): ADDRESS: CUSTOMERID#: VOGEL-1 INSURER(S) AFFORDING COVERAGE NAIC# INSURED Vogel Concrete, Inc. 6330 S College Ave Fort Collins CO 80525-4044 INSURERA: Pinnacol Assurance 41190 INSURERB: Auto -Owners Insurance Co. 18988 INSURERC: INSURER D : ' INSURER E : INSURER F : - COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT 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 CONDIfIUNS OF SUCH PULICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS B GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑X OCCUR X bink addl ins 74006127 01/17/10 01/17/11 EACH OCCURRENCE $ 10 0 0 0 0 0 REM PREMISES (Ea occurrence) $ 300000 MED EXP (Any one person) $ 10000 PERSONAL & ADV INJURY $ 1000000 GENERAL AGGREGATE $ 2000000 GENT AGGREGATE LIMIT APPLIES PER: POLICY X PROJECT LOC PRODUCTS - COMP/OP AGG $ 2 0 0 0 0 0 0 $ 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) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ X X $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE N/A EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ A ' WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N .. r�id'r'FnvrrticTviv FN:^JcFv'EiCcCuTi'v'G "'j- OFFICER/MEMBER EXCLUDED? U (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below - - ••/ A 4102132 - _ _...� -- -..__ ___ _ i_- -- 07/01/10 - - ---" —'- - 07/01/11 — -` - •-- - X - TORY LIMITS I ER - - '- -c:�.-2AC� 1 ACC S[t!T •� - -$ 1' v -. O- 9O.rJ-- .• E.L. DISEASE - EA EMPLOYEE $ 100000 E.L. DISEASE - POLICY LIMIT $ 500000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) If required by written contract or written agreement, certificate holder is included as additional insured for ongoing operations under General Liability. CERTIFICATE HOLDER CANCELLATION City of Ft. Collins Purchasing Division 215 Mason Street P.O. Box 580 Ft. Collins, CO 80522- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE FTCOLLI I THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD