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HomeMy WebLinkAbout132922 GOLTZ ASPHALT COMPANY - INSURANCE CERTIFICATEGOLTZ-1 OP ID: JO ,a►`oRo CERTIFICATE OF LIABILITY INSURANCE DATE IYYYY) 06109//09114 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 Phone: 970-482-7747 Brown & Brown Inc 4532 Boardwalk Dr, Suite 200 Fax: 970-4844165 Fort Collins, CO 80525 Tyler B. Allen CONTACT NAME: PHONE FAX Ext: AIC No: E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAC 0 INSURER As Bituminous Insurance Companies INSURED Goltz Asphalt Company J & D Leasing, LLC 3466 E. County Road 20-C B5 INSURERS: Pinnacol Assurance Company 41190 INSURER C INSURER D: Loveland, CO 80537 INSURER E : INSURER F : ls!Ii9 GWa:111i1tl91 isHVU:fa: :Iyr/L9 r119!I ILSIdyc� 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 us POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MMIDDNYYY1 LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CIAIMS-MADE OCCUR CLP3599378 02102114 02102I15 PREMISES Ear occurrence $ 100,000 MED UP (My one person) $ 5,00 PERSONAL BADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GENL AGGREGATE LIMIT APPLIES PER: POLICY A f PRO- n LOi JFcT PRODUCTS - COMP/OP AGG $ 2,000,000 $ OMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 1,000,00 BODILY IWURY(Par person) $ AANY AUTO CAP3599375 02/02114 02/02/15 ALL AUTOS OWNED X SCHEDULEDAUTOS PX BODILY INJURY (Per accident) $ HIREDAUTOS XNON-OWNED AUTOS PROPERTY DAMAGE Per accident $ $ J( UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 2,000.00 AGGREGATE $ 2,000,000 A EXCESS LIAB CWMS-MADE CUP2804888 02102114 02/02/15 DED I X I RETENTIONS 10000 $ B AND EMPLOYERS' LNIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERMIEMBER EXCLUDED? ❑ (Mandatory in NH)and Dyes.des tOkl under DESCRIPTION OF OPERATIONS below NIA 4055471 07/01114 07/01/15 X TORY IMITS I ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE $ 1,000,00 E.L. DISEASE - POLICY LIMIT $ 1,000,00 A Leased/REnted Eq ICLP3599378 02102/14 02102115 Lsd/Rntd 300,000 Ded 50C DESCRIPTION OF OPERATIONS I LOCATIONS VEHICLES (Attach ACORD 101. Additional Remarks Schedule, if more apace Is required) City of Fort Collins is included as additional insured per forme and conditions on page 2. CITYF10 City of Fort Collins 215 N. Mason St. Fort Collins, CO 80521 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 �q� �V'— ` © 1988-2010 ACORD CORPORATION. All rights reserved ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD No Text