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HomeMy WebLinkAboutADVANCED UNDERGROUND INC - INSURANCE CERTIFICATEADVA-11 OP ID: ST ,a►` oRo CERTIFICATE OF LIABILITY INSURANCE DATE 12/31/2 Y3 12/31/2013 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 endorsements . PRODUCER CRS Insurance Brokerage Commercial Risk Solutions DBA 6600 E. Hampden Ave. Denver, CO 80224 CONTACT NAME: Eric Johnson, CIC PHONE FAX c o 303-996-7801 AIC No): 303-757-7719 E-MAIL ADDRESS: Eric Johnson, CIC INSURERS AFFORDING COVERAGE NAIL B INSURER A:Westfield Insurance INSUREO_� Advanced Underground Inc INSURER B: Pinnacol Assurance Advanced Underground Services 10301 East 107th Place IINSURER C: Brighton, CO 80301 INSURER 0: 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 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 TYPE OF INSURANCE POLICY NUMBER POLICY EFF IPWD rOLICY EX! LOM GENERAL LIABILITY EACH OCCURRENCE $ 11000,000 PREMISES Ea= $ 300,00 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FXI OCCUR X CMMOS30976 01/0512014 01/0512015 MEDEXP(Anyale S 10,00 PERSONAL S ADV INJURY S 1,000,00 GENERAL AGGREGATE S. 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGO S 2,000,00( POLICY X PRO- LOC IFCT S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident)__ 1,000,00 BODILY INJURY(Pw DwwI,,) S A X ANY AUTO CMM0830976 01/06/2014 01/0612015 ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS BODILY INJURY(Pw sccdmU $ PROPERTY DAMAGE PER ACCIDENT S $ X III LI.A UA X OCCUR EACH OCCURRENCE f 6,000,00 AGGREGATE $ A ExCEM tUB -M CLAIMSADE CMM0630978 01/06i2014 01M6/2016 DED I X I RETENTION$ 10,000 $ WORKERS COMPENSATION X WC STATU- SER B LIABILITYAND EMPLOYERS' LIABILITYrrS ANY PROPRIETORRARTNER/EXECUTIVE YIN 76M 01/01/2014 01/01/2015 E.LEACH ACCIDENT $ 1,000,00 OFFICERNEMBER EXCLUDED? f 7Y (Mandawry in NH) NIA EL DISEASE - EA EMPLOYEE S 1,000A M yes. deacnhe user DESCCRIPTION OF OPERATIONS Im EL DISEASE - POLICY LIMIT 3 1,000, A Lease/Rent Equip CMM0830976 01/0512014 01105=15 Limit 100,00 Ded 1,00( DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (AIMeh ACORD 101, AddlUonal Remold Sehedala, N men aPaco Is MeA M) City of Fort Collins is included as additional insured on the General Liability with respect to ongoing operations of the named insured for the certificate holder as required by written contract. All policy terms, conditions and exclusions apply. CITYFTC 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 REPRESENTATNE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD