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HomeMy WebLinkAboutWELHAM CONCRETE INC - INSURANCE CERTIFICATE (2)ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE (MWDO YYYY) 3/8/2013 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 endorsemen s . PRODUCER Network Insurance Services,LLC 7395 E Orchard Rd -Ste A400 Greenwood Village CO 80111 NAME: PHfAJONE FAX uD N° E2rAIL ADD INSURER a AFFORDING COVERAGE NAIL 0 INSURER A:F nit Mercu[y Insurance INSURED W ELHA31 INSURER BCOlorado Casualty Co INSURER C:Pinn col Assurance of CO 411 Welham Concrete, Inc. 13545 Thomcreek Circle Thornton CO 80241 INSURER D INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 508561536 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 ADUL INSR SUER MD POLICY NUMBER POLICY EFF NIII YYYY POLICY EXP MM/DO LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE IT] OCCUR MACGL0000011008-01 22/2012 /22/2013 EACH OCCURRENCE $1.000,000 DAMAGE 10 KENED PREMISES n nce $50,000 MED EXP (My one rion) $0 PERSONAL& ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,OGO GEN'L AGGREGATE 17 POLICY LIMIT APPLIES PER: PRO- LocI PRODUCTS - COMP/OP AGG $2,000000 $ B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTO$ AUTOS HIREDAUTOS AUJTTOS�ED BA8647897 /22/2012 /22/2013 Ea S1.000.000 X BODILY INJURY IPer person) $ Y(P`a alxJdenO E AMAGE $ 8 UMBRELLA LIAB EXCESS LIAR OCCUR CLAIMS -MADE RENCE $ 4AGGREGATE $ DED RETENTION$ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER)EXECUTNE OFFICERIMEMBER EXCLUDED? � (Mandatory In NH) H yes, deschbe under DE SCRIPTION OF OPERATIONS beitm N/A 162597 11/2013 /112014 U- DTH- CIDENT $1,000.000 E.L. DISEASE- EA EMPLOYE $1.000,000 E.L. DISEASE -POLICY LIMIT $1,000.000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) City of Ft Collins is named as additional insured for General Liability. City of Fort Collins 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 R RESENTATIVE ©1988-2010 ACORO CORPORATION_ All rinhte ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: MA-CGL-0000011008-01 COMMERCIAL GENERAL LIABILITY CG 32 28 0610 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COLORADO ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) As Required By Written Contract I $10,000 BI,PD,PI,AI, Per Claim DEDUCTIBLE, Including LAE applies Residential Comp Ops t his Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only to the extent that the liability for "bodily injury' or 'property damage' is caused by "your work' at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products -completed operations hazard." CG 32 28 0610 C Insurance Service Office, Inc., 2010 Page 1 of 1