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Home My WebLink About534235 APEX PAVEMENT SOLUTIONS - INSURANCE CERTIFICATEACORO" PFS Insurance Group - DV 7200 S Alton Wayy, Ste A-140 Centennial, CO 80112 Mark Polk INSURED rnvr:R 4r: Fs YY CERTIFICATE OF LIABILITY INSURANCE Dn7ngnn1AY) 80402 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE INSURERS AFFORDING COVERAGE NAIC# INSURER A'. Acuity Insurance CO. 14184 INSIIRFR R Pinnacol Assurance Co 141190 THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TOTHE 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 BYTHE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAYHAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR ADD TYPE INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MMIDDIYYYY POLICY EXPIRATION DATE MMIDDIYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X X COMMERCIAL GENERAL LIABILITY CLAIMS MADE I —XI OCCUR X34107 01/26/2014 01/26/2015 PREMISES Ea occurence $ 300,00 MED EXP (Any one person) $ 10,00 X Blkt AI on/comp) PERSONAL & ADV INJURY $ 1,000,00 Blk Waive of Subr GENERAL AGGREGATE $ 3,000,00 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG $ 3,000.00 POLICY PRO LOC A X AUTOMOBILE LIABILITY ANY AUTO X34107 01 /26/2014 01126/2015 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,00 X BODILY INJURY (PER PERSON) $ ALL OWNED AUTOS SCHEDULED AUTOS HIREDAUTOS NON OWNED AUTOS X BODILY INJURY (PER ACCIDENT) $ X PROPERTY DAMAGE IPER ACCDENT) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ THAN EA ACC $ ANY AUTO ..OTHER T ' AUTO ONLY: qG6 EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE S 1,000,00 A X OCCUR CLAIMS MADE X34107 ' 01126/2014. OV26/2015 AGGREGATE $ 1,000,00 8 $ DEDUCTIBLE X RETENTION $ none $ B B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORPARMERrFJ4=NTIVE YIN OFFICERIMEMBER EXCLUDED? (Mandatory in NH) fps describe under SPECIAL PROVISIONS below 153529 BLKTWAIVER OF SUBROGATIO 02/0112014 02/01/2015 X WCSTATU X OTH- TORY LIMITS ER EL EACH ACCIDENT $ 500,00 EL DISEASE - EA EMPLOYEE $ 500,00 E. L. DISEASE - POLICY LIMIT $ SOQ,00 OTHER A Property Section X34107 01126/2014 0126/2015 equip 208,40 A Equip Floater X34107 01/26/2014 01/26/2015 bpp 10,00 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS The certificate holder is included as additional insured for ongoing and completed operations under general liability and designated insured under automobile liability (except hired and nonovmed automobile). l.fula: d•\.Raiy�b\IT�1J CITYFCI SHOULDANY OF THEASOVE DESCRIBED POLICIES BE CANCELLED BEFORE THEEXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN City of Fort Collins NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Engineering Department IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR P.O. BOX 580 REPRESENTATNES. Fort Collins, CO 80522 AUTHORIZED REPRESENTATIVE At.UKU 20 (ZUUB/01) O 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD APEXP-1 OP ID: VM IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER This Certificate of Insurance does not constitute a contract between the issuing insurer(s), authored representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2009/01)