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HomeMy WebLinkAboutDIAMOND EXCAVATING INC - INSURANCE CERTIFICATE (4)DIAMEXC-01 SFORSBERG A�ORO CERTIFICATE OF LIABILITY INSURANCE DATE (MMI014 DONWY 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 Forsberg Engerman Co 3575 S Sherman St Englewood, CO 60113 CONTACT NAME: Sarah Forsber -Tripp PHONE FAX Xt No E: (303) 762-1717 ac Na: (303) 762-1733 A RIESS: INSURERS AFFORDING COVERAGE NAIC Is INSURER A: Cincinnati Insurance Companies 10677 INSURED INSURER 8:PInnaCOI Assurance 41190 INSURERC: Diamond Excavating Inc INSURER D: 5940 W 59th Ave Arvada, CO 80003 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 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 CONTRACTOR 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 INSURANCE21111111 POLICY NUMBER M DDIYYYY) IMM/DDNYYYl LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE T OCCUR X ENP 0172168 01/07/2014 01/0712016 EACH OCCURRENCE $ 1,000,00 PREMISES Eaocwnence $ 500,00 MED EXP (Any one Person) $ 10,00 PERSONAL &ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER. POLICY JE� LOC OTHER'. GENEFR LAGGREGATE $ 2,000,00 PRODUCTS - COMPIOP AGG $ 2,000,00 $ A AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS X HIRED AUTOS X AUTOS NON -OWNED ENP 0172168 01/07/2014 01/07/2015 COMBINED SINGLE LIMIT Es accldenl $ 1,000,00 BODILY INJURY (Per parson) $ BODILY INJURY (Per accident) $ (PRar �Rdent) E $ $ A X l UMBRELLA LIAS EXCESS LIAB X OCCUR CLAIMS -MADE ENP 0172168 01/07/2014 01/07/2015 EACH OCCURRENCE $ 5,000,00 AGGREGATE $ 5,000,00 I DED X RETENTION IS 10,000 Is B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNEWEXECUTIVE Y� OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes describe under DESCRIPTION OF OPERATIONS belox NIA 2296640 04/01I2014 04/01/2015 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE -EA EMPLOYEE $ 1,000,00 E.L. DISEASE -POLICY LIMIT $ 1,000,00 A Leased/Rented Equip ENP 0172168 01/07/2014 01/07/2015 Limit 300,00 DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If mom space Is required) RE: Right of Way Contractor License The City of Fort Collins is named as additional insured with respect to general liability per form GA233CO 05/11. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Fort Collins THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 580 Ft Collins, CO 80522-0580 AUTHORIZED REPRESENTATIVE d �� ACORD 25 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD