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HomeMy WebLinkAbout471395 J A R CONCRETE LLC - INSURANCE CERTIFICATE303-776-4670 To:1-970-221-6707 City of Fort Collins(1 of 1) 05-04-2011 01:15 PM -0600 CERTIFICATE OF LIABILITY INSURANCE 4�7/2011 ""' 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 First Mainstreet Insurance, LLC 512 4th Avenue P.O. BOX 847 Longmont CO 80502 CONTACT NAME: Debbie Brickham EXt: (303) 776-5122 FAX, (PA HONE., No: (303)776-5495 E-MAIL s: dbrickham@FirstMainStreet.com ADDRE PRODUCER 00023126 CUSTOMER ID k: INSURER(S) AFFORDING COVERAGE NAICk INSURED J.A.R. Concrete, LLC J.A.R. Holdings, LLC 11621 Weld County Road 13 Longmont CO 80504 INSURERA :Owners Insurance Co/Auto Owners INSURERBAuto Owners Insurance Co. 18988 INSURERC:Pinnacol Assurance INSURERD: INSURER E 1 INSURERF: COVERAGES CERTIFICATE NUMBER:11-12 Master 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. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR ME POLICY NUMBER POLICY EFF MMIDDIYYYYI POLICY EXP (MMIDDIYYYYI LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMSMADEOCCUR 74586182 4/1/2011 4/1/2012 EACH OCCURRENCE $ 1,000,000 PREMISES Ea occurrence $ 300,000 DIED EXP(Any one person) $ 10,000 PERSONAL &ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE L APPLIES PER X POLI CV PRO LOC CT PRODUCTS -COMP/OPAGO $ 2,000,000 $ A AUTOMOBILE LIABILITY A ALL OWNED AUTOS OWNED SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS 9758618200 9/1/2011 9/1/2012 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ X X Uninsured motorist Bl split limit $ 1,000,000 Medical payments $ 5, 000 B X UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE 4758618201 4/1/2011 9/l/2012 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 DEDUCTIBLE I RETENTION $ 10,000 $ X $ L. WORKERS COMPENSATION AND EMPLOYERS'LIABILIT( YIN ANY OFFICERMEMBEOR EXCLUDEDXECUTIVE� (Mandatory in NEI If yes, describe under DESCRIPTION OF OPERATIONS below NIA 4072304 8/1/2010 8/1/2011 X WC STATU- OTH- TORY LIMITS ER EL EACH ACCIDENT $ 1,000,000 EL DISEASEEAEMPLOYEE $ 1,000,000 E.L. DISEASE -POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) City of Fort Collins as additional insured with respect to general liability per Form 55372, when required by written contract. CERTIFICATE HOLDER CANCELLATION (970) 221-6707 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Fort Collins Purchasing & Risk Management AUTHORIZED REPRESENTATIVE P O BOX 580 Fort Collins, CO 80522-0580 D Brickham/DBRICK;-s-`-=-1-=`�----- ACORD 25 (2009/09) © 1988-2009 ACORD CORPORATION. All rights reserved. INS025 (200909) The ACORD name and logo are registered marks of ACORD