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HomeMy WebLinkAboutTROY FORMING CONCRETE INC - INSURANCE CERTIFICATEClient#: 68123 8TROYFOR ACORD,., CERTIFICATE OF LIABILITY INSURANCE DATE(MWDD/YYYY) 3/31/2011 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 Willis of Colorado, Inc. 720 South Colorado Boulevard Suite 60ON Denver, CO 80246 CONTACT NAME: PHONE FAX A/C No Ext: INC, No: E-MAIL ADDRESS: INSURERS) AFFORDING COVERAGE NAIC p INSURER A: First Mercury Insurance Company 10657 INSURED Troy Forming Concrete, Inc. 957 Salida Way Aurora, CO 80011 INSURERS: Plnnacol Assurance 41190 INSURER CAllianz Global Risk US 35300 INSURERD: Praetorian Insurance Company 37303 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 CONTRACTOR 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. INSR LTR TYPE OF INSURANCE ADDLSUBR INSR WVD POLICY NUMBER POLICY EFF fMMIDD POLICY EXP MMIDD/YI`yY LIMITS A GENERALLIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 51OCCUR X BI/PD Ded:5,000 FMMA0026423 4/01/2011 04101/2012 EACH OCCURRENCE $100D 000 PREMISES EaEacTwEarse $50000 MED EXP (Any one Person) $ PERSONAL B ADV INJURY $1,000,000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY nX PRO LOD JECT PRODUCTS - COMP/OP AGG $2,000,000 $ D AUTOMOBILE LIABILITY ANY AUTO ALL OWNED X SCHEDULED AUTOS AUTOS HIRED AUTOS X NON -OWNED AUTOS PICC00002221 4/01/2011 04/01/201 EOMaBINEEDtSINGLELIMIT 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ X PROPERTY DAMAGE Per accident $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNEPIEXECUTIVE YIN OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) It yes, descdGe under DESCRIPTION OF OPERATIONS below N/A 4103394 4/01/2011 04/01/2012 X WCSTAT1- OTH- ELACH ACCIDENT EACH ACCIDENT $ ELDISEASE EA EMPLOYEE $1,000,000 E.L. DISEASE -POLICY LIMIT $1,000,000 C Lease/Rent Equip Metal/Wood Forms 7 MZ193030240 4/01/2011 04/01/2012 $200,000 $400,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is requlmd) Per Project Aggregate- $5,000,000 limit applies City of Fort Collins P.O. Box 580 Fort Collins, CO 80521 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2010105) 1 of 1 #S773100/M773034 ©1988.2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 8NPER