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HomeMy WebLinkAbout202421 CUTLER REPAVING COMPANY INC - INSURANCE CERTIFICATEOP ID: SJ CERTIFICATE OF LIABILITY INSURANCE DAT07/28/11YYY) 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' .-- 913-396-0800 Johnston Fiss Insurance :: `._. 5225 West 75th Street,-#200- - - 913-396-0835 Shawnee Mission, KS 66208 NRMEACT Sandy Jones PHONE A/c NP E,t) 913-396-0812 we No): 913-396-0835 ADDRESS: sandyjones@johnstonfiss.coin Ron Johnson l ( PRODUCER CUTLE-2 CUSTOMER ID #: INSURER 5 AFFORDING COVERAGE NAIC # INSURED Cutler Repaving Company, Inc. INSURER A: Wausau Underwriters 26042 INSURER B: LibertyInsurance Corporation 42404 Attn: Bob Veskerna 921 E. 27th Street INSURER C : Cincinnati Insurance Co. 10677 Lawrence, KS 66046 INSURER D: Wausau BUSIneSS IDS CO 26069 INSURER E : INSURER F : COVERAGES CFRTIFICATF 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 LTR TYPE OF INSURANCE ABETVot POLICY NUMBER POLICY EFF MM IDDNYYY POLICY EXP MM/DD/YYYY LIMITS D GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR X Waiver Of Subro YVK-Z91-457438-031 - 08/01/11 .. 08/01/12 - EACH OCCURRENCE $ 1,000,00 0^Mn ET RENTED PREMISES Ea occurrence $ 300,00 MED EXP (Any one person) $ 10,00 PERSONAL &ADV INJURY $ 1,000,00 X Blkt Add1 Insci GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER. POLICY I -XI PRO _ LOC I'llAUTOMOBILE PRODUCTS - COMP/OP AGO $ 2,000,00 Emp Ben• $ 1,000,00 A LIABILITY - ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNEDAUTOS Blkt Add'I lnsd ASJ-Z91-47438-021, 08/01/11 08/01/12 COMBINED SINGLE LIMIT ' (Ea accident) $ . 1,000,000 - X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ X X $ X $ C X UMBRELLA LIAR EXCESS LIP B X OCCUR CLAIMS -MADE CCC1152728 08/01111 OB/01N2 EACH OCCURRENCE $ 5,000,00 AGGREGATE $ 5,000,00 DEDUCTIBLE RETENTION $ $ X $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE Y/N OFFICERIMEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N I A WC7-Z91-457438-011 08101111 08/01/12 X WC STATUS OTH- T RV LIMITS ER EL. EACH ACCIDENT $ 500,08 E.L. DISEASE - EA EMPLOYEE $ 500,00 EL.DISEASE -POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS I LOCATIONS I LES (Attac CORD 101. Additional Remarks Schedule, If more apace Is resulted) RE: Hot In Place Recycling Pro act Bid No. 6077 .)2011 Renewal The City of Fort Collins is Additional I ured Ifn-going and completed operations. Insurance is primary and Non- ontributory. Waiver of subrogation applies where permitted by law CERTIFICATE HOLDER CANCELLATION FORC001 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City Of Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS. Purchasing Division Financial Services AUTHORIZED REPRESENTATIVE PG Box 580 Fort Collins, CO 80522 ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD