The URL can be used to link to this page

Home My WebLink About389648 A-1 CHIPSEAL COMPANY - INSURANCE CERTIFICATE (10)IICERTIFICATE OF LIABILITY INSURANCE DATE (MM DDI 9/26/2013 V) 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: N 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 Moody Insurance Agency, Inc. 8055 East Tufts Avenue CONTNAME.ACT Nick SiakotoS, ARM, CRI$ PHONE . (303)824-6600 No_(303)370-011$ E-MAIL .nsiakotos@moodyins.com Suite 1000 Denver CO 80237 INSURERS AFFORDING COVERAGE NAIL INSURERA:Phoenix Insurance Company 5623 INSURED ` INSURERS:Travelers Pr Cas Co of Amrca 5674 A-1 �O INSURERC:Pinnacol Assurance 41190 INSURER D: DBA: Rocky Mountain Pavement, LLC 2001 West 64th Ln INSURER E: Denver CO 80221 1 INSURER F: 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 POLICY NUMBER POLICY EFF Y POLICY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 21000,000 PREMISES occurrence) $ 300,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ®OCCUR X DTC00190P673PEX13 0/1/2013 0/1/2014 MED EXP (Any onePerson) $ 10,000 PERSONAL AOV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 dditional Insured Endt GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 when required by contract POLICY FX PRO - LOC I kGD246 08/05 attached $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT2,000,000 X BODILY INJURY (Per person) $ B ANY AUTO ALL SCHEDULED X T8100190P673TIL33 0/1/2013 0/1/2014 BODILY INJURY(Per aaident) $ 'e HIRED AUTOS X NON OWNED AUTOS(Per.. PROPERTY DAMAGE $ X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10, 000, 000 B EXCESS LIAR CLAIMS -MADE DIED I X I RETENTION 10-OOG $ DTSMCUP0190P673TIL13 0/1/2013 0/1/2014 C WORKERS COMPENSATION ANDEMPLOYERS'LIASILITY YIN ANY PROPRIETOR/PARTNEIVEXECUTIVE OFFICEWMEMBER EXQDDEDe I (Mandatory in NH) If yae, describe under DESCRIPTION OF OPERATIONS below N/A 055760 0/1/2013 10/1/2014 XI WC STA U- H- E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 E.L. DISEASE -POLICY LIMIT $ 500100 DESCRIPTION OF OPERATIONS LOCATIONS/VEHICLES (Attach ACORD 101, Additional Remarks Sctredule, X more space is required) Re: Asphalt Surface Treatment Project --Renewal for Addition work Fall 2013 The City of Fort Collins is included as an Additional Insured with respect to General and Automobile Liability as required by written contract. City of Fort Collins 300 Laporte Ave 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 REPRESENTATIVE Threlkeld, CRIS/RRI �-.d__t4_ 1988.2010 ACORD CORPORATION_ All rights reserved INS025(2010M) 01 The ACORD name and logo are registered marks of ACORD ,d►coRo® CERTIFICATE OF LIABILITY INSURANCE `� DATE (MSVY) 9/26/2013013 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: It the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. H 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 Moody Insurance Agency, Inc. 8055 East Tufts Avenue Suite 1000 Denver CO 80237 rciONTAc Nick Siakotos, ARM, CRIS PHONE (303)624-6600 1FiUC N (303)370-011$ Z)*AILEss.nsiakotos@moodyins.com OR INSURERS AFFORDING COVERAGE NAIL# INSURER A:PhoeniX Insurance Company 5623 INSURED A-1 Chipseal Company DBA: Rocky Mountain Pavement, LLC 2001 west 64th Ln Denver CO 80221 INSURERB:Travelers Prop Cab CO Of Amrca 25674 INSURERC:Pinnacol Assurance 41190 INSURER D: INSURER E: 1 INSURER F: COVERAGES CERTIFICATE NUMBER:13-14 All Lines w Forme RFVISIr1N NIIMRFR- 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 LTA TYPE OF INSURANCE ADOLSUBm POLICY NUMBER POLICY EFF POLICY EXP YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 11000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Me occurrent $ 300,000 A CLAIMS -MADE I —XI OCCUR X DTC00190P673PKX13 0/1/2013 0/l/2014 MED EXP (Any one arson $ 10,000 PERSONAL 6 ADV INJURY $ 11000,000 GENERAL AGGREGATE $ 2,000,000 Additional Insured Endt GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $ 2,000,000 when required by contract 17 POLICY Fil PRO-7 LOC I KW246 08/05 attached $ AUTOMOBILE LIABILITY COMBIN e INGL LIMI 1 000 000 X BODILY INJURY (Per person) $ B ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS X T8100190P673TIL13 10/1/2013 10/1/2014 'Y HIRED AUTOS X NON -OWNED AUTOS PROPERTY DAMAGE Far accident UMBRELLA LIAR X OCCUR EACH OCCURRENCE AGGREGATE BEXCESS LIAB CLAIMS -MADE DED X RETENTION$ 10,00 R$500,000 SMCUP0190P673TIL13 0/1/2013 0/l/2014 C WORKERS COMPENSATION WC STA U- OTHAND EMPLOYERS' LIABILITY Y/NANY EL EACH ACCIDENT PROPRIETORIPARTNERIEXECUTIVE N/A(Mandatory OFFICERIMEMBER EXCLUDED? in NH) 055760 0/1/2013 0/1/2014 E.L. DISEASE -EA EMPLOYE If Yea. deecr6e under E.L. DISEASE -POLICY LIMIT 1 $ 500,000 DE SCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Amch ACORD 101, Additional Remarks Schedule, R more apace is required) Re: BID 7256 Hot Applied Chipseal Overlay--2013 Renewal The City of Fort Collins is included as an Additional Insured with respect to General and Automobile Liability as required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS. 300 Laporte Ave AUTHORIZED REPRESENTATIVE Fort Collins, CO 80522 H Threlkeld, CRIS/XRI ACORD 25 (2010ro5) INS025 (2oloo5).ol 01988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD