HomeMy WebLinkAbout122133 HILGENBERG EXCAVATING INC - INSURANCE CERTIFICATE (2)�R7® CERTIFICATE OF LIABILITY INSURANCE OF ID DA
DA0(MMIDD(YYY)
06 04 12
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 1 l i V�
V j
NAME:
A/C, No, Ext: INC, No):
Brown & Brown Inc 1
ADDRESS:
4532 Boardwalk Dr, Suite 00
Fort Collins CO 80525
-PRODUCER
CUSTOMER Io a: HILGE-1
Phone:970-482-7747 Fax:9 0-484-4165
INSURER(S) AFFORDING COVERAGE
NAICa
INSURED
INSURER A: Colorado Casualty Ins Cc
41785
Hilyenberg Excavating, Inc.
201Hyline Dr
Fort Collins CO 80526
INSURER B:
INSURER C:
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.
LTR
TYPE OF INSURANCE
ADO
INSR
SUB
MID
NUMBER
CYEFF
(MM/DDIYYYYI
POLICY EXP
(MM/OD/YYYY)
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE F—xl OCCUR
CBP8634079
06/02/12
06/02 /13
EACH OCCURRENCE
PREMS S(Ea occccurrrence)
$ 1,000,000
$ 100,000
MED EXP(Any one person)
$ 15,000
PERSONAL B ADV INJURY
$1,000,000
GENERAL AGGREGATE
s 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER
POLICY � JECOT F LOC
PRODUCTS - COMP/OP AGG
s2,000,000
A
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
BA8635979
06/02/12
06/02/13
COMBINED SINGLE LIMIT
(Eaaccitlen0
$1,000,000
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
X
PROPERTY DAMAGE
(Per accident)
$
X
X
$
$
UMBRELLA LIAR
EXCESS LIAR
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
$
AGGREGATE
$
DEDUCTIBLE
RETENTION $
8
Is
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETORIPARTNER/EXECUTIVEn
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
If as, describe under
DESCRIPTION OF OPERATIONS below
NIA
TORY LIMITS I I ER
E.L. EACH ACCIDENT
$
E.L. DISEASE- EA EMPLOYEE
$
E.L. DISEASE- POLICY LIMIT
1 $
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
See Notes:
CERTIFICATE HOLDER CANCELLATION
Ft. Collins Police Department
300 LaPorte Avenue
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
FTCPOLD I THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
ACORD CORPORATIC ![� All
ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD