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HomeMy WebLinkAboutMETRO PAVERS INC - INSURANCE CERTIFICATE (2)IVIC 1 MU-L yr Iv. ar ,acoRO• CERTIFICATE OF LIABILITY TY INSURANCE DAT10/13D/YYYYI 0/13/11 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 970-635-9400 PFS Insurance Group - JT 970-635-9401 4848 Thompson Pkwy, Ste 200 Johnstown, CO 80534 CONTACT NAME: FAX PHONE AIC No): A/C No Ext : E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC If Mark Polk INSURER A: Mountain States Insurance Grp INSURED Metro Pavers, Inc. 7875 1-76 Service Road Henderson, CO 80640 INSURERB: Pinnacol Assurance Co 524210 INSURERC: INSURER D INSURER E INSURER F COVERAGES VCR 1 Ir WN 1 C Ir VIr1oC n. - -- --- 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 A TYPE OF INSURANCE GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Fx-1 OCCUR X Add'ilns'd ADDL SUBR I POLICY NUMBER CPP0131947 POLICY EFF MM/DD 10/01111 POLICY EXP MWDD 10/01/12 LIMITS EACH OCCURRENCE $ 1,000,000 DAMAGES ( RENTED PREMISES Ea occurrence $ 300 000 MED EXP (Any one person) $ 10,000 PERSONAL BADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 X Wvr Of Sub - PRODUCTSCOMP/OP AGG $ 2,000,000 E LIMIT APPLIES PER: GEN'L AGGREGATE POLICY xlPRO n LOC AUTOMOBILE LIABILITY COMBINED Ea accidetSINGLE LIMIT $ $ 1,000,000 BODILY INJURY (Per person) $ A X ANY AUTO ALLOWNED SCHEDULED AUTOS AUTOS NON -OWNED HIREDAUTOS AUTOS X 1,000 Comp X 1,000 Coll BAP0131947 10/01/11 10/01/12 BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ $ A X UMBRELLA UAB EXCESS LIAR X OCCUR CLAIMS -MADE UMB0131947 10/01/11 10/01/12 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 X WC STATU- X OTH- MIT $ DED X I RETENTION $ None WORKERS COMPENSATION E.L. EACH ACCIDENT $ 500,000 B AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, tlesaibe antler DESCRIPTION OF OPERATIONS below NIA 1656962 10/01/11 - 10/11/12 E.L. DISEASE - EA EMPLOYEE $ 500,000 E.L. DISEASE - POLICY LIMIT $ 500,000 A A Buildings Limit Leased/Rented Limi CPP0131947 CPP0131947 10/01/11 10/01/11 10/01/12 10/01/12 Limit s15,00i Limit 100,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) If required by written contract or written agreement, the certificate holder is included as additional insured for ongoing operations under general liability. City of Fort Collins P.O. Box 580 Fort Collins, CO 80522 FTCOLLI 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 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD