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HomeMy WebLinkAboutBORUNDA CONCRETE - INSURANCE CERTIFICATE (2)t1UKUN-1 UP IU: bA .acoRO` CERTIFICATE OF LIABILITY INSURANCE �i DATE(MMJDDNYYY) 0 sn z 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 PFS Insurance Group - JT 4848 Thompson Pkwy, Ste 200 970-635-9401 PHONE FAX AIL No Est : INC, No): Johnstown, CO 80534 Johnstown Select Accounts EMAIL ADDRESS: INSURERS) AFFORDING COVERAGE NAICO INSURERA -Pin nacol Assurance Co 41190 INSURED Borunda Concrete INSURERB: Attn: Noe Borunda 6407 Buchanan St. INsuRERc: 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 Li — LTR TYPE OFINSURANCE ADDLSUBRIMDII POLICY NUMBER MWDDYEFF MMIDDIYYYY LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 1:1 OCCUR EACH OCCURRENCE DAMAGETO RENTED PREMISES Eaoccurrenca) MED EXP(Any one per $ $ $ PERSONAL BADV INJURY 1 $ GENERAL AGGREGATE $ GENL AGGREGATE LIMITAPPLIES PER POLICY PRO n LOC PRODUCTS - COMPIOP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS AUTOSWNED COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) S $ BODILY INJURY (Per accident) $ (p r..d.nt)OPERTY AMAGE Ir $ $ UMBRELLA LIAB OCCUR EXCESS LIAB CLAIMSJdADE ❑ED RETENTION$ EACH OCCURRENCE 1 AGGREGATE Ij $ 3 A WORKERS COMPENSATION ANDEMPLOYERS'LIABILITY ANY PROPRIETOI RTNER XECUTIVE YIN OFFICERNEMBER EXCLUDED? (Mandatory In NIP I f YYes, describe un Ider D SCRIPTIONOF OPERATIONS below N I A 4107058 08/01/12 08101113 WC STATU- I IOTH- X TORV-LIMITS�LER E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYEE $ 100,00 EL. DISEASE -POLICY LIMIT 1 $ 500,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more spec¢ Is required) Concrete Construction/All Locations/All Operations CITYFTC City of Fort Collins 215 North Mason Fort Collins, CO 80525 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WALL BE DEUVERED 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