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Home My WebLink About452108 EDGE CONCRETE INC - INSURANCE CERTIFICATE (5)`T"}`�" CERTIFICATE OF LIABILITY INSURANCE 8/16/20Y 02 S/16/2012 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 CONTACT NAME:ME,Katie Klimek Ewing -Leavitt Insurance Agency (AIIC,No Est. 970.679.7375 (`ic,Ne):866.456.4265 4025 St. Cloud Dr. Suite 100 /q1 Loveland, CO 80538 ��' E-MAIL ADDRESS: katie-klimek@leavitt.com PRODUCER 00gg487Q CU STOMERIDN: INSURER(S) AFFORDING COVERAGE NAICIs INSURED INSURER A: Secura Insurance 22543 Edge Concrete, Inc. INSURERB: Pinnacol Assurance 41190 1040 South Railroad Avenue INSURER C: Loveland, CO 8Q537 INSURER D: INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 12/13 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 OFINSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MMRIDIYYYY POLICY EXP MM/DD/YYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR X Bl kt Addl t Insd TC315287507/31/2012 07/3112013 EACH OCCURRENCE $ 1,000,00 DAMAGE TO RENTED PREMISES Ea occurrence $ 100' QQ MED EXP (Any one person) S 5,000 PERSONAL &ADV INJURY $ Include X BLkt Waiv of Sub GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICYEX] PRO- JECT LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO ALLOWNEDAUTOS SCHEDULED AUTOS HIREDAUTOS NON-OWNEDAUTOS A315287607131/2012 07/31/2013 CO BI aeDI,INGLE LIMIT (EaBODILY $ 1,000, 000 INJURY (Per person) $ BODILY INJURY(Peracudeni) $ X PROPERTY DAMAGE (Per accitlent) $ X X $ UMBRELLA LMB EXCESS UAS OCCUR CLAIMS -MADE ----- EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ B WORKERS COMPENSATION AND EMPLO ERS' IABILIITY YIN OFFICER/MEMBEREXCLUDED?TH ANY PROPRIETORIPECUTIVE❑ (Mandatory in NH) It yes, describe under DESCRIPTION OF OPERATIONS below NIA 413347208I01I2012 08I01I2013 X TORY LIM TS ER E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE -POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, AddlUonal Remarks Schedule, If more space is required) Project: Soapstone ertificate holder is named as additional insured as respects general liability. FAX: '970'221.6707 Director of Purchasing & Risk Management PO Box 580 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 All rights reserved ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD ACORD CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 08/16/2012 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 CONTACT NAME: Katie Klimek Ewing -Leavitt Insurance Agency a/c°°"N A/CNa:866.456.4265 EXt:970.679.7375 4025 St. Cloud Dr. E-MAIL katie-klimek@leavitt.com ADDRESS: Suite 100 PRODUCER 00004870 CUSTOMER ID #: Loveland, CO 80538 INSURER(S) AFFORDING COVERAGE NAIC# INSURED INSURERA: Secura Insurance 22543 Edge Concrete, Inc. INSURERB: Pinnacol Assurance 41190 1040 South Railroad Avenue INSURERC: Loveland, CO 80537 INSURERD: INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 12/13 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 TYPE OF INSURANCE ADDLSUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 7v� OCCUR X Bl kt Addl t Insd TC315287507/31/2012 07/31/2013 EACH OCCURRENCE $ 1,000,00 DAMAGE TO RENTED PREMISES Ea occurrence $ 100 00 � MED EXP (Any one person) $ 5,000 PERSONAL &ADV INJURY $ Included X BLkt Waiv of Sub GENERAL AGGREGATE $ 2,000,00 GENT AGGREGATE LIMIT APPLIES PER: POLICY X PROCT LOC JE PRODUCTS - COMP/OP AGG $ 2,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS A315287 07/31/2012 07/31/2013 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,00 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ $ $ X PROPERTY DAMAGE (Per accident) X X $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION S $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE I OFFICER/MEMBER EXCLUDED? u (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A 4133472 08/01 /2012 08/01 /2013 X TORY L MITS OT ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Certificate holder is also an Addtional Insured. 11 Locations / All Operations CERTIFICATE HOLDER CANCELLATION FAX: 970.221.6378 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Fort Collins AUTHORIZED REPRESENTATIVE ( I Engineering Department 281 North College Ave. Fort Collins, CO 80522-0580 Katie Klimek/KAMCAV U 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD