HomeMy WebLinkAboutCUTLER REPAVING INC - INSURANCE CERTIFICATE�F" CERTIFICATE OF LIABILITY INSURANCE OP ID SJ
DATE(MM/DD/YYYY)
07 21/10
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
NAME:
Johnston Fiss Insurance
PHONE FAX
A/C, No, Ext : (A/C, No):
ADDRESS:
5225 West 75th Street, . #200
PRODUCER
CUSTOMERID#: CUTLE-2
Shawnee Mission KS 66208
Phone:913-396-0800 Fax:913-396-0835
INSURER(S) AFFORDING COVERAGE
NAIC#
INSURED
INSURER A: Hartford Underwriters Ins Co.
Cutler Repaving, Inc.
Attn: Bob Veskerna
INSURERB: Hartford Fire Insurance Co
29424
INSURERC: Twin City Fire Insurance Co
921 E. 27th Street
Lawrence KS 66046
INSURERD: Cincinnati Insurance Co.
10677
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 CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR
TYPE OF INSURANCE
INSR
WVD
POLICY NUMBER
(MM/DD/YYYY)
(MM/DD/YYYY)
LIMITS
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE FX-1 OCCUR
X Waiver of Subro
37CQT1562
08/01/10
08/01/11
EACH OCCURRENCE
$ 1,000,000
A AU:A
PREMISES (Ea occurrence)
$ 300,000
MED EXP (Any one person)
$ 10,000
PERSONAL BADVINJURY .
$ 1,000,000
X
Blkt Add' 1 Insd
GENERAL AGGREGATE
s2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY X JECPROT LOC
PRODUCTS - COMP/OP AGG
s2,000,000
Emp Ben.
$ 1 , 000 , 000
B
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
37UENQT1563
08/01/10
08/01/11
COMBINED SINGLE LIMIT
accident)
$ 1,000,000
X
BODILY
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
X
X
$
D
X
UMBRELLA LIAB
EXCESS LIAR
X
OCCUR
CLAIMS -MADE
CCC1152728
08/01/10
08/01/11
EACH OCCURRENCE
s4,000,000
AGGREGATE
$ 4,000,000
DEDUCTIBLE -
RETENTION $ 0
$
X
$
C
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIV
OFFICER/MEMBEREXCLUDE(
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
/A
37WEQT2118
08/01/10
_
08/01/11
X I W TATU- TH-
TORY LIMITS ER
E.L. EACH ACCIDENT
$500000
E.L. DISEASE - EA EMPLOYEE
s500000
E.L. DISEASE -POLICY LIMIT
s500000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
RE: Bid # 6077 Hot In Place Recycling Project- 2010 Renewal
The City of Fort Collins is Additional Insured for on -going and completed
operations. Insurance is prima and Non -Contributory. Waver of
u sbrogation applies where permiti
permitted by law
CERTIFICATE HOLDER CANCELLATION
City of Fort Collins
Financial Services
Purchasing Division
215 North Mason St, 2nd Floor
Fort Collins CO 80522
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
FTCCO01 I THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
REPRESENTATIVE
n 1988-2009 AC6RD CORPORATION All rinht6 rPCPNPrt
ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD