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HomeMy WebLinkAbout353928 CONCRETE STABILIZATION TECHNOLOGIES INC - INSURANCE CERTIFICATEACORO® CERTIFICATE OF LIABILITY INSURANCE DATE IMMIDONYYY) 9/13/2012 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 endorsements . PRODUCER Van Gilder Insurance Corp. 1515 Wynkoop, Suite 200 Denver CO 80202 CONTACT NAME: PHONE ,/I�E,D_@ ac Nc : - - E-MAIL ADDREss: t Fa0ygic com INSURERS AFFORDING COVERAGE NAIL# NSURERA:l aniQo Specialty-ImuLaaae-CmDa 5 INSURED INSURER B:HanoMer InsvranCB Concrete Stabilization Technologies,lnc INSURERC:Pinnacol Assurance INSURER D: 8500 E. Warren Avenue Denver CO 80231 INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER: 1128443647 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 INSR SUER WVD POLICY NUMBER I POLICY EFF MMIDDIYYYY POLICY EXP MMIDDIYYYV LIMITS A GENERAL LIABILITY VGL1141454 1/1/2012 /1/2013 EACH OCCURRENCE $t,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $50,000 CLAIMS -MADE a OCCUR LED EXP (Any one person) $ PERSONAL B ADV INJURY $1,000.000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGE $2,000,000 Deductible $5,000 POPRO- F LOG LICY I^ e AHF898407501 1/1/2012 /1/2013 Ea aocidem I51,000,000 ANY AUTO BODILYINJURY(Perperson) $ POMOUILELUNBLITY ALL OWNED SCHEDULED ALT$HIRED BODILY INJURY(PeracodentAUTOS Peacciden DAMAGE $ AUTOS X A TOSWNED A UMBRELLALIAa X I OCCUR VUE1121538 1/1/2012 1/1/2013 EACH OCCURRENCE $2,000,000 AGGREGATE $2,000,000 X EXCESS LIAB CLAIMS -MADE DED RETENTION$ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTNE OFFICERIMEMBER EXCLUDEDI ❑ N I A 1 4121092 1/1/2012 /1/2013 X WC STATU- OTH RV IMIi E.L. EACH ACCIDENT $500,000 (Mandatory in NH) E.L. DISEASEEAEMPLOYE $500.000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1 $500.000 A Slop Gap Employers VGL1141454 11/1/2012 Each Accident $1,000,000 Liability �11/2013 Each Employee $1,000,000 Aggregate $1,000.000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more Space IS required) "Workers Compensation coverage does not apply to employees who are hired or reside in the States of ND, OH, WA or WY. Employers Liability Stop Gap coverage applies to the State." AS required by written contract or written agreement, City of Fort Collins , its officers, agents, and employees, (only as their interest applies as party to the contract) are included as Additional Insured for ongoing operations under the General Liability and Designated Insured under the Automobile Liability. City of Fort Collins PO Box 580 Ft 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 © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD