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Home My WebLink About202421 CUTLER REPAVING INC - INSURANCE CERTIFICATE (2)�1 A!'rlO rl= CUTLE-2 OP ID: SJ CERTIFICATE OF LIABILITY INSURANCE °ATn71?RI1 YYY) o7nana 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 THE POLICIES BY BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURE BY 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 . PRODUCERCONTAC Johnston Fist Insurance Phone:913-396-0800 NAME, Sandy Jones Street, #200 Fax: 913-396-0835 $225 West 75thMission, Shawnee Mission, KS 66208 Ron Johnson PAID° No Ell' 913-396-0812 ac No : 913-396-0835 E.ntaL ADDRESS: sand 'ones 'Ohnstonf ss.COm INSURE S AFFORDING COVERAGE NAIC9 INSURED Cutler Repaving, Inc. Attn: Bob Veskerna INSURERA: WaUSaU Underwriters INSURER B: Liberty Insurance Corporation 26042 42404 INSURERC: Wausau Business Ins Co 26069 921 E. 27th Street INSURER D: Lawrence, KS 66046-4917 INSURER E NSURERF: CCIVFRAGF4 '-"-"' ''^' ^"'•"' REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR LTR TYPE OF INSURANCE GENERAL LIABILITY POLICY NUMBER MMIDDYD/YEYVY MwDDNY P LIMITS C X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR X Blkt Add'I Insd X K-Z91-457438-031 08/01/14 0810111$ EACH OCCURRENCE $ 1,000,00 PREMISES Ea occurrenra $ 300,00 IVIED EXP (Any one person) $ 10,00 PERSONAL B ADV INJURY $ 1,000,00 X Blkt WaiverlSubro GENERAL AGGREGATE $ 2,000,00 A ASC-Z91457438-022 08101114 08/01/15 GENT AGGREGATE LIMIT APPLIES PER: PRO LOC POUCYFx-1 AUTOMOBILE LIABILITY X ANY WIVEUTO ALL OWNED SCHEDULED AUTOS AUTOS X HIRED AUTOS X AUTTOSWNED X PRODUCTS - COMPIOP AGG $ 2,000,00 Emp Ben. COMBINED SINGLE LIMIT Ea accident s 1,000,00 $ 1,000,00 BODILY INJURY (Par person) $ BODILY INJURY(Pw accident) s PROPERTYDAMAGE Per accident $ EACH OCCURRENCE $ 5,000,00 B UMBRE X EXCESS LAB X OCCUR EXCESSUAB CLAIMS -MADE TH7-Z91457438-053 08/01/14 08/01/15 GREGATE $ 5,000,00 DEO X RETENTION$ 101000 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICERIMEM EREXCLUDED?ANY ECUTIVE Yr (Mandatory In NH) NIA C7-Z91457438-012 08/01/14 OS/01/15 WC STATU- OTH- :E.L.D1SEAqF-PnIIr.VIIUIT $ EACH CCIDENT E 1,000,Q0 DISEASE -EA EMPLOYEE $ 1,000,00 Il yes, tlescribe uMar DESCRIPTION OF OPERATIONS balox E 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) Re: 7513 Hot -In -Place Recycling Project - 2014 Renewal The City of Ft. Collins, co is additional insurd as respects the General Liability and Auto Liability as required by contract. CERTIFICATE 1-I4711 nrP CITYF01 City of Fort Collins 300 Laport 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 — ,aw-<u sw a V VKU LVKVUKA I IUN. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD