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HomeMy WebLinkAboutBORUNDA CONCRETE - INSURANCE CERTIFICATEBORUN-1 OP ID: BA CERTIFICATE OF LIABILITY INSURANCE DAT07/19DYYYY) F on1 sn 1 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 endorsements . PRODUCER 970-635.9400 CONTACT NAME: PFS Insurance Group -J7 970-635-9401 4848 Thompson Pkwy, Ste 200 PHONE FAX A/C No, Ext): AIC No;: Johnstown, CO 80534 Johnstown Select Accounts E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC Y INSURER A: Plnnacol Assurance Co 41190 INSURED Borunda Concrete Attn: Noe Borunda 6407 Buchanan St. INSURER B: INSURER C Fort Collins, CO 80525 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 CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUe POLICY EFF POLICY EXP LTR POLICY NUMBER MMIDDIYYYY MMIDD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMA D PREMISES Ea occurzence $ CLAIMS -MADE 1:1OCCUR MED EXP (Any one person) $ PERSONAL A ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS - COMPIOP AGG. $ POLICY PRO- LOC $ AUTOMOBILE LIABILITY _ COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO - ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPEId.nt) AGE Per accident $ NON -OWNED OS HIRED AUTAUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE S AGGREGATE $ EXCESS LIAR CLAIMS -MADE DED RETENTION$ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORRARTNEB/EXECUTIVE Y/N OFFICERIMEMBER EXCLUDED? ❑ (Mandatory In NH) NIA 4107058 08I01111 08101112 X WC STATU- OTH- 2 E.L. EACH ACCIDENT $ 100,000 E. L. DISEASE - EA EMPLOYEE $ 100,000 If yes, describe under DESCRIPTION OF OPERATIONS below E. L. DISEASE -POLICY LIMIT S 500.000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remark, Schedule, If more space Is required) CITYOFC City of Fort Collins Purchasing Division 2nd Floor 215 North Mason Street 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 4a�� © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD