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Home My WebLink AboutTROY FORMING CONCRETE INC - INSURANCE CERTIFICATE (2)Page 1 of 2 �`v �® CERTIFICATE OF LIABILITY INSURANCE DA03/26 2 4 03/26/2019 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 Willis of Colorado, Inc. c/o 26 Century Blvd CONTACT NAME: PHONE Fa,.1-877-945-73711 FF% 1 .1-BB8-467-2370 P.O. Box 305191 E-MAIL eertificates4eillia.c0m ADDRESS: Nashville, IN 372305191 USA AFFORDING COVERAGE NAM:e INSURER A: Pirat s ercturr In muster i C—PMY 20657 INSURED Troy Bormin0 Concrmte, Ism. INSURER e: Praetoria6 Iasarame Conpmy 37237 INSURERC:Plmaccl Aaanranca CessInany 42190 998 Salida Way Aurora, CO 80011 INsURERO:A0C0 Marine Iaeursnoe ceswedny 22837 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER:W2633e2 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. LM TYPE OF INSURANCE INSR ADDL BR POLICY NUMBER PC MMIDDIIUCYFFE POUCYE)CP LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FK OCCUR BI / PD Dad:1115,000 NA-CGL-0000008496-03 04/131/2014 04/01/2015 EACH OCCURRENCE s 1,000,000 $ 50,000 MED EXP (Any mm ndn s 51000 PERSONAL A ADV INJURY $ 11000,000 GENERAL AGGREGATE $ 2,000,000 GENL AGGREGATE LIMIT APPUES PER: -XI POLICY FX PRO- LOG PRODUCTS -COMPIOPAGG $ 21000,000 S B AUTOMOBILE LIABILITY ANY AUTO ALL GOWNED X �OSULED HIRED AUTOS X NON -OWNED AUTOS PICM0004028 04/01/2014 04/01/2015 COMBINED SINGLE LIMIT (Epao;idardl S 11000,000 BODILY INJURY (Per perm) S BODILY INJURY (Per sodden) S X PROPERTY DAMAGE y E UMBRELLA LIAR EXCESS LAB OCCUR CIAIMS.MADE EACH OCCURRENCE $ AGGREGATE S DED I I RETENTION S C WORKERS COMPENSATION AND EMPLOYERS LABILITY YIN ANY PROPRIETORIPARTNER/ ECUrIVE OFFICERMIEMBER EXCLUDED? (Maeda" In NH) rc yea, desoibe units, DESCRIPTION OF OPERATIONS helav NIA 4103394 04/01/2014 04/01/2015 X I WCSTATU- OTF4 TORY LIMITS EL EACH ACCIDENT $ 11000,000 EL DISEASE -EA EMPLOY $ 11000,000 EL DISEASE - POLICY LIMIT S 2,000,000 D Bueiaese Personal Property M 193030240 04/01/2014 04/01/2015 60,000/61,000 deduetible DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Aeach ACORD 101, Additional Rem *a Sdia ule, B mom spare is nmuin ll 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 REPRESENTATNE City of Fort Collins P.O. Box 580 ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD SR ID:3651123 BATCB:Barch 9: 39169 AGENCY CUSTOMER ID: LOC M A � ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Willis of Colorado, Inc. Troy Porning Concrete, Inc. 998 Salida Nay POLICY NUMBER See Page 1 Aurora, CO 00011 CARRIER NAIC CODE See Page 1 Sae Page 1 EFFECTVE DATE: See Paga 1 THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Cart ficate of LiaEility Insurance INSURCR AFPONGING CGnL : AGCS Narina Insurance Coe¢any MLICY NUMBER: M193030240 EFF DATE: 04/01/2014 EXP DATE: 04/01/2015 ]YPL OF INSURANCE: LIMITS: Lassed/Rented Eguiraant $200,000 GD161o5L7Li11 NAIC1: 22837 CJ 2008 ACORD CORPORATION. All riahts reserved. The ACORD name and logo are r ec�istered marks of ACORD 365I123 B- N 0 39169 W263382