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HomeMy WebLinkAbout353928 CONCRETE STABILIZATION TECHNOLOGIES INC - INSURANCE CERTIFICATE (2)ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/O0mryYy) 1/2/2013 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 CONTA NAME: PAN 0NE FAX INC.No .M-831-5285 Van Gilder Insurance Corp. 1515 Wynkoop, Suite 200 Denver CO 80202 E MAR AooREss: r v i INSURERS AFFORDING COVERAGE NNC# INSURER A:Companion Specialty Insurance Compa INSURED 0 INSURERS Rifinacol-Assurance Concrete Stabilization Technologies, Inc INSURERC:The_Cincinnati Insurance_Company 8500 E. Warren Avenue Denver CO 80231 INSURER D: INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 978342144 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 rypE OF INSURANCE ADDL INSR SUER WVO POLICY NUMBER POLICY EFF MM/ODIYYYY POLICY EXP MMmD/YYYY LIMITS A GENERAL LIABILITY NGL1351957 1112013 11/2014 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMA T NTED PREMISES Ea occvmence $50,000 CIAIMS-MADE IX I OCCUR MEO EXP (My one person) $ PERSONAL S ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $2,000,000 Deductible $10,000 POLICY X PRO- LOC JECT C UAB1uTY EPP0173576 1/1/2013 /1/2014 Ea accid.,A $1,000,000 BODILY INJURY(Per parson) s ANYAUTO POMOBILE ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per aPudenl) $ PROPERTY ST HIRED AUTOS X ""WNED AUTOS S A UMBRELLALIAB X OCCUR VUE1332058 1/1/2013 1/1/2014 EACH OCCURRENCE $2,000,000 X AGGREGATE $2.000,000 EXCESS UAB CLAIMS -MADE DED RETENTION$ $ B WORKERS COMPENSATION 4121092 1/1/2013 /1/2014 X WC STATU- OTH- AND EMPLOYERS' LIABILITY Y/ N ANY PROPRIETORIPARTNER/EXECUTIVE E.L. EACH ACCIDENT $500,000 OFFICERIMEMBER EXCLUDED? ❑ NIA E.L. DISEASE - EA EMPLOYE $500,000 (Mandatory In NH) Uneyes. describe under RIPTION OF OPERATIONS bola, E.L. DISEASE -POLICY LIMIT 1 $500,000 A Stop Gap -Employers 1131_1351957 1/1/2013 11/2014 Each Accident $1,000,000 Liability -Wyoming 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. 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. AUTHORREPRESENTATIVE © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD