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Home My WebLink About103166 ZAK DIRT INC - INSURANCE CERTIFICATETJ�li7 �1 ~`'""Lill CERTIFICATE OF LIABILITY INSURANCE D09/07/2012ATE7/2012 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: Renee McReynolds Ewing -Leavitt Insurance Agency °a"CCN E,rt:970.679.7344 acNq:866.425.6180 4025 St. Cloud Dr. ADDRESS: renee-mcreynolds@leavitt.com Suite 100 Loveland, CO 80538 PRODUCER 00000729 CUSTOMER ID #: INSURER(S) AFFORDING COVERAGE NAIC# INSURED ),, INSURERA: Cincinnati Insurance Co Zak Dirt, Inc. r1 INSURERS: Pinnacol Assurance 41190 14290 Hilltop Road INSURER C Longmont, CO 80504 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 REOUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR 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 rypE OF INSURANCE ADDL INSR SUER WVD POLICYNUMBER POLICY EFF MMIDDA'YYY POLICY EXP MMIDDIYYVY LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE [X] OCCUR X Blkt Addl Insureds CPP108410610101/2012 10/01/2013 EACH OCCURRENCE $ 1,000,00 DAMAGE TO RENTED PREMISES Ea occurrence $ S00 00 , MED EXP (Any one person) $ 10,000 PERSONAL &ADV INJURY $ 1,000,00 X Blkt Waiver Subrog GENERALAGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PROJECT LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIREDAUTOS NON -OWNED AUTOS Blkt WOS/Addl Insd CPP1084106 1010112012 10/0112013 COMBINEDSINGLE LIMIT Ea accident S 1,000,000 ' oOQ, QQQ X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ X X Comprehensive $ 1000 ded X Collision $ 1000 de A X UMBRELLALIAB EXCESS LIAR I X OCCUR CLAIMS -MADE CPPI08410610/01/2012 10/01/2013 EACH OCCURRENCE $ 5,000,00 AGGREGATE $ S,000,00 DEDUCTIBLE RETENTION $ $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILIry YIN OANY FFICERIMEM EREXCLUDR/pxECUTIVE❑ (Mandatory in NH) If Dyes, describe under DESCRIPTION OF OPERATIONS below NIA 84662 INCL BLANKET WAIVE OF SUBROGATIO 10I01I2012 10/01/2013 X TORY LIWE MITS R EL. EACHACCIDENT $ 500,000 E. L. DISEASE -EA EMPLOYEE $ SQQ, QQQ E.L. DISEASE- POLICY LIMIT $ 500,000 A Contractors' Equipment CPP1084106 10/01/2012 1010112013 Leased/Rented Equipment $500,000 limit DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ANach ACORD 101, Additional Remarks Schedule, if more space Is required) e: Shields & Laporte, Fort Collins, CO #314.12 he City of Fort Collins and Colorado Department of Transportation are named as additional nsureds as respects work performed. City of Fort Collins 215 N Mason St Forst Collins, CO 8OS22 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. REPRESENTATIVE All rights reserved ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD