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Home My WebLink About541246 FRENCH CONCRETE INC - INSURANCE CERTIFICATECERTIFICATE OF LIABILITY INSURANCE DATEIYrmaYYYr) 09l032D14 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 Is THE isINSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: n the ........ holder is an ADDITIONAL INSURED, the p;; zp ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endoreemerd. A s.'annard on this certificate does not confer rights to the certificate holder in lieu of such endorse ment(s). PRODUCER Jim Canfield Agency NTADTChds Kesterson NAME: tY State Farm Insurance StateFarm PHONENo Ee1:9706694t21 FAX g7a66y-0620 � 2291 W Eisenhower Blvd Loveland, AD Ess: jim.caufeld.bul 'xm: b�statefarm.00m e COVERAGE y • • CO 80537 INSURED French Concrete Inc INSURER A:State Farm Fire and Oasualty-- - -- Company 261g3 PO Box 193 — INSURERS:--- _ iNSURERD:_— INSURER D.— Masonville, CO 80541-0193 INSURERE: --- COVERAGES CERTIFICATE NUMRFR INSUREa P: — I HIS 15 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW ncrlatvn INUMNCII: INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOOR OTHER DOCUMENT INSURED NAMED AWITH RESPECT TO WHICH BOVE FOR THE POUCY PERIOD 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 RAVE BEEN REDUCED BY PAID CLAIMS IT �_�....,.�_. A J( COMMERCKI-GENERALUABILITY I y CLAMS -MADE I -xi OCCUR GENL AGGREGATE LFUR APPLIES PER: X POLICY �L ^ PRO- u JECT L LOG OTHER: AUTONDBILE llA61lJTY ANY AUTO AOWHEO AUTOS SCHEDULED AUTOS HIRED AUTOS NONg1MIED AUTOS., UMBRELLA LIAB OCCUR AND EMPLOYERS' LIABILITY YIN' ANY PROPRIETORIPARTNENrrXECUTIVE OFFICERMFMBER EXCLUDED? NIA [Mandatory In NH) If vas der�in M.� 96-B2-P231-2 10410312014 I ON031201 S I EACH OCCURRENCE S 5,000.000 iaGET6REN5Eri -- — ILP_RE—MISES En pxurtenm j 700,000 MED EXP (Ary pee person) j 5,000 UENERAL AGGREGATE S PRODUCTS - COMPIOP AGO S S Eaa&uldant INGLE LIMB S J_. BODILY INJURY (Par perep) j BOOLYINJUHY(Perapjdert) j �� Pa�acpiaertlD�A� j DESCMPTION Or OPERATIONS I LOCATIONS/ VEHICLES tACORD 101, AdYUenet " MM ScMdule, may M M Inxl N pn N spats Is rogaYyd) The City of Fort Collins is included as Additional Insured as respects General Liability, subject to the terms, conditions and exclusions of the policy. 10,000.000 City of Fort Collins Director of Purchasing and Risk Management [THE HOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE PO BOX SBO g E7(PIRA7ION DATE THEREOF, NOTICE WILLBE DELIVERED IN CCORDANCE WITH THE POLICY PROVISIONS. Fort coIllrls, co 8os2zRORSZED REPRESENTATIVE ACORD 25 (2014/01) The ACORD name and logo are registered marks a -ACORD 2014 RD CORPORATION. All rights reserved. 1001486 132849.9 02-04-2014 VEHICLE OR EQUIPMENT CERTIFICATE OF INSURANCE DAM(AMMOONYM 0910312014 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. This form is used to report coverages provided to a single speck vehicle or Provided to multiple vehicles under a single policy. equipment. Do not use this form to report liability coverage g poll Use ACORD 25 for that purpose. PRODUCER CONTACT NAME: Christy Kesterson StateFarm State Farm Insurance, Jim Caufield Agency PHONE 2291 W Eisenhower Blvd ac N0 gM. 970-660-4121 AX Al Loveland CO 80537 ARmE�o jim.Caufeld.bulb@Statefann.com INSURED Joshua French PO Box 193 Masonville, CO 80541-0193 State Farm Mutual Automobile YEAR MAKE I MANUFACTU HER MODEL 1999 Ford F450 BODY TYPE VEHICLE IDENTIFICATION NUMBER oEscwpnoN Oatbed 1FDXW46FDXEC91947 SERIAL NUMBER COVERAGES CERTIFICATE NUMBER: THIS IS TO CERTIFY THAT THE HSTAN (IES) OF INSURANCE LISTED BELOW HAS/HAVE BEEN ISSUED TO THE INREVISIURED NON NU AIB ERE.FOR PERIOD(S) INDICATED, NOTWITHSTANDING THE POLICY ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICY(IES). INSURANCE AFFORDED BY THE POLICY(IES) DESCRIBED HEREIN ISlARE SUBJECT TO INSR AarL LTR INSRD TYPE OFINSURANCE POLICY NUMBER PODCYEFFECTIVE PODCYEXPINATION X DATE(MMIDDIYYYY) mM(MNIDDffM LIMITS LE VEHN:LIgB1I1TY A COMBINED SINGLE LIMIT $ 1,000000 . 1728428-EO7-06F ... 05/072014 BODILY INJURY(PerparSon) S 11/072014 . BODILY INJURY (Per eCdd M) S - GENERAL LIABILITY PROPERTY DAMAGE S OCCURRENCE EACH OCCURENCE $ CLAIMS MADE GENERALAGGREGATE $ IRISH LOSS f LTR Aw TYPE OF INSURANCE POLICY NUMBER POIJCYEFFECTIVE PCUCYEXPIRATIDN VEH COLLISION LOSS DATE(NMIDDrYYy) DATE(MMM,,, n WITS/DEDUCTIBLE ' ❑ ACV ❑ AGREED AMT S LIMIT WHCOMP VEH OTC ❑ ❑STATED AMT `f LIED ❑ ACV ❑ AGREED AM-1- S LIMIT PROPERTY ❑ ❑ STATEOAMT S DED BASICH BROAD ❑ ACV ❑ AGREED AMT SPECIAL ❑ RG ❑ STMTEDAMT s LIMIT ❑ S DIED REMARKS (INCLUDING SPECIAL CONOMONSI OTHER COVERAGES) (Allech ACORD 101, AWMImaI Rame,,e S,1w1W.. If Mery apeu Ie reWNrad) The City of Fort Collins is included as Additional Insured as respects Auto Liability, subject to the terms, Conditions & exclusions of Me ADDITIONAL INTEREST policies. Select one of Ne following: CANCELLATION Tb eddifi"I ir/elast daevibed bM e, Ees Ewen addM to Me Pd'^Yf�) i"re0 ^eren MPdxY^u (S) been abmiUM M and UM etldeolwl Interest de11rb1d tNx rapper SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE XA n b Ie 010,L N.) F ed Eaein0 di ni nb e DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. VEHICLEI EDUIPNENT INTEREST: LEABED FINANCED MANE AND ADDRESS OF ADDITIONAL INTEREST DESCRIPTION OF THE ADDITIONAL INTEREST City of Fort Collins X ADDITIONALINSURED LOSS PAYEE Director of Purchasing and Risk Management LENDrnr$ LOW PAYEE PO Box 560 LOAM /LEASE NUNBER Fort Collins, CO 80522 ACORD 23 (2010105) The ACORD name and logo are registered marks of ACORD All IOD4361 142987.2 01-28-2013