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HomeMy WebLinkAbout202421 CUTLER REPAVING INC - INSURANCE CERTIFICATEOP ID: SJ '4 �R� CERTIFICATE OF LIABILITY INSURANCE DATDYYYY) 07127 on27n 2 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 Johnston Fiss Insurance 913-396-0800 5225 West 75th Street, #200 913-396-0835 Shawnee Mission, KS 66208 Ron Johnson CONTACT NAME: Sandy Jones PICO." o Eat , 913-396-0812 FAX No): 913-396-0835 DREEo Ail-ss: sand 'ones 'ohnstonfiss.com PRODUCER CUTLE-2 CUSTOMER ID e: INSURERS AFFORDING COVERAGE NAIC d INSURED Cutler Repaving, Inc. INSURERA: Wausau Underwriters 26042 Attn: Bob Veskerna INSURER B:Liberty Insurance Corporation 42404 921 E. 27th Street Lawrence, KS 66046 INSURER C : Cincinnati Insurance Co. 10677 INSURER D: WaQBaD BUSIDOSS IDS Co 26069 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 LTR TYPE OF INSURANCE ADDL SUBRPOLICY Jm POLICY NUMBER EFF MMIDDIYYYY POLICY EXP MMIDD/YYYY LIMITS D GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FxI OCCUR X Blkt Add'llnsd X YVK-Z91-457438-031 08/01/12 08101113 EACH OCCURRENCE $ 1,000,000 PREMISES E.a¢un.. S 300,000 MED EXP (Any one person) $ 10,000 PERSONAL B ADV INJURY S 1,000,000 X WalVer Ofsubro GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER'. POLICY X PRO LOC PRODUCTS - COMP/OP AGG $ 2,000,000 Emp Ben. $ 1,000,000 A AUTOMOBILE LIABILITY ANY auro ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNEDAUTOS SJ-Z91 �57438-021 08I01112 08I01I13 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Par accident) $ X PROPERTY DAMAGE (Per accident) $ X $ $ C X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE CCC1152728 08101N2 08101l13 EACH OCCURRENCE $ 5,000,00 AGGREGATE $ 5,000,00 DEDUCTIBLE RETENTION $ g X g B WORKERS COMPENSATION AND EMPLOYERS' LIABILITYDRY ANY PROPRIETORIPARTNER,EXECUTIVE YIN OFFICERNEMBER EXCLUDED? ❑N (Mandatory In NH) It yes, describe under DESCRIPTION OF OPERATIONS below N/A I I I C7-Z91-457438-011 08/01/12 08101/13 X I WC STATU- OTH- E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE -FA EMPLOYEE $ 1,000,000 EASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Pro ect: 6077 Hot in Place Recycling Project - 2012 Renewal. City of Fort Collins, CO is named as Additional Insured as respects this project CITYF01 City of Fort Collins 300 Laport Ave. Fort Collins, CO 80522 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 ©1988.2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD