No preview available
HomeMy WebLinkAbout103166 ZAK DIRT INC - INSURANCE CERTIFICATE (2)ACORD CERTIFICATE OF LIABILITY INSURANCE M DATE09/25/2013 5/2013 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 endorsement(s). PRODUCER Ewing -Leavitt Insurance Agency 4025 St. Cloud Dr. Suite 100 Loveland, CO 80538 CONTACT NAME: Renee McReynolds 'HONE 970.619.7144 a c,Ne:866.42S.6180 (aC, No Eat: n OAIL ss: renee-mcreynolds@leavitt.com INSURER($) AFFORDING COVERAGE NAICN INSURER A: Cincinnati Insurance Co 10677 INSURED Zak Dirt, Inc. 14290 Hilltop Road 1030 Longmont, CO 80SO4 INSURERS: Pinnacol Assurance 41190 INSURERC: INSURERD: INSURER E : INSURER F: COVERAGES CERTIFICATE NUMBER: 13-14 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE INSR MD POLICY NUMBER MMIDONYYY MMMO LIMIT$ A GENERAL LIABILITY X COMMERCIAL GENERALLIABILITY CLAIMS -MADE T OCCUR X Blkt Addl Insureds CPPI084106 10/01/2013 10/0112014 EACH OCCURRENCE $ 1,000,00 PREMISES Ea occurrence $ S00,00 I EXP (Any one person) $ S,000 PERSONAL& ADV INJURY $ 1,000,00 X Blkt Waiver Subrog GENERAL AGGREGATE $ 2.000,00 GEML AGGREGATE LIMIT APPLIES PER: X PRO- POLICYECT LOC PRODUCTS -COMPIOPAGG $ 2,000,00 $ AALL AUTOMOBILE LIABILITY JX ANY AUTO OWNED SCHEDULED AUTOS AUTOSHIREDAUTOS X NON -OWNED AUTOS Blkt WOS I X IB1kt Al CPP1084106 10/01/2013 10101/2014 ecddenl $ 1,000,00( BODILY INJURY(Per person) $ BODILY INJURY (Per accltlent) $ Per PEKIaccident) $ omp/Coll $ 1000 de A X UMBRELLA LIAR EXCESS LIAB X OCCUR CLAIMS -MADE CPPI08410 I 10/01/2013 I 10/01/2014 EACH OCCURRENCE $ S,000,00 AGGREGATE $ 5,000,00C DELI X RETEt1r10N$ Q I I $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVi�� OFRCERIMEMBER EXCLUDED? L� (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A 84662 INCL BLANKET WAIVE OF SUBROGATIO 10/0112013 10101/2014 X TORY LIMITS ER E.L. EACH ACCIDENT $ 500,00 E.L. DISEASE - EA EMPLOYE $ 500,00 E.L. DISEASE -POLICY LIMIT $ 500,00 A rntractors' Equipment CPP108410 10101/20131010112014 $500,000 limit Leased/Rented Equipment DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remaks 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 insureds as respects work performed. laliim ala Lp_\a a i Dj alaj 9C 9G1 f Pf H al L. I I lejc City of Fort Collins 215 N Mason St 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 PROwSIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD