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HomeMy WebLinkAbout471395 J A R CONCRETE LLC - INSURANCE CERTIFICATE (3)�`c� CERTIFICATE OF LIABILITY INSURANCE DATE /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 ICONTACT Debbie Hrickham First Mainstreet Insurance, LLC 512 4th Avenue..-_ - - P.O. Box 847 INSURED J.A.R. Concrete, LLC J.A.R. Holdings, LLC 11621 Weld County Road 13 CO 80504 (303)776-5122- {ac,-No):-(3oB dbrickham@FirstMainStreet.Cem- - IDa00023126 INSURER(S) AFFORDING COVERAGE Owners Insurance Co/Auto Owners Assurance I'll Con r_CC rr RTIFICATF NIIMRFR-11-12 Master RFVISION NIJMRFR- )776-5495 - 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. ILTR TYPE OF INSURANCE Aq RI WVD POLICY NUMBER MM/DD/YYYY MM%D�YIYYYY LIMITS GENERAL LIABILITY I EACH OCCURRENCE S 1,000,000 COMMERCIAL ii COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED — PREMISES_(Eeoccurrence_ 300,-000 $ 10,000 A GLAIMS-MADE 1XIOCCUR 74586182 4/1/2011 4/1/2012 MED EXP(Any one person) PERSONALB ADV INJURY $--- 1,000,000 GENERAL AGGREGATE --$ ---21000,000 GGEEN'L AGGREGATE LIMIT APPLIES PER (PRODUCTS - COMPIOP AGG $ 2,000,000 X 1 POLICY rI PRO n LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X _ BODILY INJURY (Per person) $ A ANY AUTO ALL OWNED AUTOS 4758618200 4/1/2011 4/1/2012 BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ SCHEDULED AUTOS HIRED AUTOS _ X X Uninsured motorist Bl split limit l$ 1,000,000 NONOWNEDAUTOS Medical payments $ 5,000 j{ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS -MADE AGGREGATE $ 1,000,000 DEDUCTIBLE $ B X RETENTION S 10 000 4758618201 4/1/2011 4/1/2012 Is C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? h (Mandatory in NH) NIA '4072304 4072304 08/01/201108/01/2012[XJTORYLIMIU- /1/2010 8/1/2011 �R E.L. EACH ACCIDENT s 1,000,000 E.L. DISEASE - EA EMPLOYE $ 1,000,000 E.L. DISEASE -POLICY LIMIT $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / 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. (970)221-6707 City of Fort Collins Purchasing 6 Risk Management P O Box 580 Fort Collins, CO 80522-0580 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 Brickham/DBRICK Cc119RR-2009 ACORD CORPORATION. All riahts reserved. INS025 (200909) - The ACORD name and logo are registered marks of ACORD �`c� CERTIFICATE OF LIABILITY INSURANCE DATE /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 ICONTACT Debbie Hrickham First Mainstreet Insurance, LLC 512 4th Avenue..-_ - - P.O. Box 847 INSURED J.A.R. Concrete, LLC J.A.R. Holdings, LLC 11621 Weld County Road 13 CO 80504 (303)776-5122- {ac,-No):-(3oB dbrickham@FirstMainStreet.Cem- - IDa00023126 INSURER(S) AFFORDING COVERAGE Owners Insurance Co/Auto Owners Assurance I'll Con r_CC rr RTIFICATF NIIMRFR-11-12 Master RFVISION NIJMRFR- )776-5495 - 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. ILTR TYPE OF INSURANCE Aq RI WVD POLICY NUMBER MM/DD/YYYY MM%D�YIYYYY LIMITS GENERAL LIABILITY I EACH OCCURRENCE S 1,000,000 COMMERCIAL ii COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED — PREMISES_(Eeoccurrence_ 300,-000 $ 10,000 A GLAIMS-MADE 1XIOCCUR 74586182 4/1/2011 4/1/2012 MED EXP(Any one person) PERSONALB ADV INJURY $--- 1,000,000 GENERAL AGGREGATE --$ ---21000,000 GGEEN'L AGGREGATE LIMIT APPLIES PER (PRODUCTS - COMPIOP AGG $ 2,000,000 X 1 POLICY rI PRO n LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X _ BODILY INJURY (Per person) $ A ANY AUTO ALL OWNED AUTOS 4758618200 4/1/2011 4/1/2012 BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ SCHEDULED AUTOS HIRED AUTOS _ X X Uninsured motorist Bl split limit l$ 1,000,000 NONOWNEDAUTOS Medical payments $ 5,000 j{ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS -MADE AGGREGATE $ 1,000,000 DEDUCTIBLE $ B X RETENTION S 10 000 4758618201 4/1/2011 4/1/2012 Is C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? h (Mandatory in NH) NIA '4072304 4072304 08/01/201108/01/2012[XJTORYLIMIU- /1/2010 8/1/2011 �R E.L. EACH ACCIDENT s 1,000,000 E.L. DISEASE - EA EMPLOYE $ 1,000,000 E.L. DISEASE -POLICY LIMIT $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / 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. (970)221-6707 City of Fort Collins Purchasing 6 Risk Management P O Box 580 Fort Collins, CO 80522-0580 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 Brickham/DBRICK Cc119RR-2009 ACORD CORPORATION. All riahts reserved. INS025 (200909) - The ACORD name and logo are registered marks of ACORD �`� CERTIFICATE OF LIABILITY INSURANCE 7/2/2011 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 CONTACT Debbie Brickhar. NAME: First Mainstreet Insurance, LLC IPAHONIE E.n (303)776-5122 la No): (303)776-5495 512 4th Avenue _E-MAIL s: dbrickham@Firs t24ainStreet. com P.O. BOX 847 PRODUCER 00023126 _CUSTOMER ID N: LOnQIBOnt CO 80502 INSURERS) AFFORDING COVERAGE NAICN INSURED INSURERA:Owners Insurance J.A.R. Concrete, LLC INSURERB:Anto Owners Insu J.A.R. Holdings, LLC INSURER C:Pinnacol Assuran 11621 Weld County Road 13 INRIIRFR D: (Longmont CO 80504 (INSURER F: cr1VFRAr69A CFRTIFICATF NIIMRFR•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 ADOLSUBR POLICY EFF POLICY E%P LTR TYPE OF INSURANCE IIN RWVD POLICY NUMBER MMIDOIYYYY MMIDDIYYYY LIMITS A G_,E_NERAL LIABILITY I h COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR 74586182 4/1/2011 4/1/2012 EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occurrence) Is 1,000,000 $ 300, 000 NED EXP(Any one person) S 10,000 PERSONALS ADV INJURY $ 1:000,000 GENERAL AGGREGATE $ 2000,000 GEEN' L AGGREGATE LIMIT APPLIES PER'. IX][ POLICY PRO LOC PRODUCTS - COMP/OP AGG Is 2,000,000 I $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NOWOWNED AUTOS 4758618200 4/1/2011 4/1/2012 COMBINED SINGLE LIMIT (Ea accident) S 1,000,000 X BODILY INJURY (Par person) I$ BODILY INJURY (Per accident) 8 PROPERTY DAMAGE (Per accident) $ X X Uninsured motorist Bl split limit $ 1,000,000 Medical payments $ 5,000 H }{ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE 4758618201 4/1/2011 4/1/2012 EACH OCCU RRENCE s 1,000,000 AGGREGATE Is 1,000,000 DEDUCTIBLE RETENTION $ 10 000 I $ X Is C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/ N OFFICER/MEMBER EXCLUDED? y (Mandatory in NH) If yes describe under DESCRIPTION OF OPERATIONS below N/A 14072304 4072304 O8/01/2o1108/01/2012 B/1/2010 B/1/2011 TORYLMTSL�ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE 8 1 , 000,000 E.L. DISEASE -POLICY LIMIT Is 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Rou arks Schedule, if more space is required) (970)224-6134 City of Fort Collins Building & Zoning Dept Contractors Licensing P O Box 580 Fort Collins. CO 80522-0580 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 Brickham/DBRICK ACORD 25 (2009/09) ©1988-2009 ACORD CORPORATION. All rights reserved. INS025 (200909) The ACORD name and logo are registered marks of ACORD �`� CERTIFICATE OF LIABILITY INSURANCE 7/2/2011 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 CONTACT Debbie Brickhar. NAME: First Mainstreet Insurance, LLC IPAHONIE E.n (303)776-5122 la No): (303)776-5495 512 4th Avenue _E-MAIL s: dbrickham@Firs t24ainStreet. com P.O. BOX 847 PRODUCER 00023126 _CUSTOMER ID N: LOnQIBOnt CO 80502 INSURERS) AFFORDING COVERAGE NAICN INSURED INSURERA:Owners Insurance J.A.R. Concrete, LLC INSURERB:Anto Owners Insu J.A.R. Holdings, LLC INSURER C:Pinnacol Assuran 11621 Weld County Road 13 INRIIRFR D: (Longmont CO 80504 (INSURER F: cr1VFRAr69A CFRTIFICATF NIIMRFR•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 ADOLSUBR POLICY EFF POLICY E%P LTR TYPE OF INSURANCE IIN RWVD POLICY NUMBER MMIDOIYYYY MMIDDIYYYY LIMITS A G_,E_NERAL LIABILITY I h COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR 74586182 4/1/2011 4/1/2012 EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occurrence) Is 1,000,000 $ 300, 000 NED EXP(Any one person) S 10,000 PERSONALS ADV INJURY $ 1:000,000 GENERAL AGGREGATE $ 2000,000 GEEN' L AGGREGATE LIMIT APPLIES PER'. IX][ POLICY PRO LOC PRODUCTS - COMP/OP AGG Is 2,000,000 I $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NOWOWNED AUTOS 4758618200 4/1/2011 4/1/2012 COMBINED SINGLE LIMIT (Ea accident) S 1,000,000 X BODILY INJURY (Par person) I$ BODILY INJURY (Per accident) 8 PROPERTY DAMAGE (Per accident) $ X X Uninsured motorist Bl split limit $ 1,000,000 Medical payments $ 5,000 H }{ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE 4758618201 4/1/2011 4/1/2012 EACH OCCU RRENCE s 1,000,000 AGGREGATE Is 1,000,000 DEDUCTIBLE RETENTION $ 10 000 I $ X Is C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/ N OFFICER/MEMBER EXCLUDED? y (Mandatory in NH) If yes describe under DESCRIPTION OF OPERATIONS below N/A 14072304 4072304 O8/01/2o1108/01/2012 B/1/2010 B/1/2011 TORYLMTSL�ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE 8 1 , 000,000 E.L. DISEASE -POLICY LIMIT Is 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Rou arks Schedule, if more space is required) (970)224-6134 City of Fort Collins Building & Zoning Dept Contractors Licensing P O Box 580 Fort Collins. CO 80522-0580 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 Brickham/DBRICK ACORD 25 (2009/09) ©1988-2009 ACORD CORPORATION. All rights reserved. INS025 (200909) The ACORD name and logo are registered marks of ACORD