HomeMy WebLinkAboutWESTERN CONCRETE CONTRACTORS INC - INSURANCE CERTIFICATEPSEMNEam
Ac oRp® CERTIFICATE OF LIABILITY INSURANCE °09/0� �'
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 1-303-534-4567 CONTACT
NAME:_
INA, Inc. - Colorado Division PHONE FA%
INC. No. Ey;_ -_ .. _ __--___ _ �LAIC.Ne)_-
EJORE denPamDimacorp.com
1705 17tb 9CrBe[ ADDRESS:
Suite 100 _ INSURERIS)AFFORDING COVERAGE _ NNC/
Denver, CO 80202 INSURER A: CHARTER 0" FIRS INS CO (TRAVELERS) _25615_ _
INSURED ---- _- -� _ ---- INSURERS: TRAVSLERS IND CO _— - 25658
Western Concrete Contractors, Inc. INSURERC: TBX_ VSLESS PROP CAS CO OF AMER _ _ 2567_4__ _
3401 Quebec Street, Suite 9105 INSURER D: PINNACOL _ASSUR _ _ _ 41190
INSURERS.
Denver, CO 80207 INSURER F:
COVERAGES CERTIFICATE NUMBER: 41311895 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.
risalm ADDL;TYPE OF INSURANCE raml UBR1 POLN:Y NUMBER MINDONYr I YIDCDIYYYY I LIMITS
A
COMMERCLLLGENERALLIABIl1fY
4TC06D43112ACCP14
09/01/14
09/01/15
EACH OCCURRENCE
f 1,000,000
%
CAIMS-TMDE I X I OCCUR
DAMAGE TO RENTED
PREMISES.(E. occumnce)__
f 300,000
_ME_DEXP(M_y_mepers )_
$ 5,000
PERSONAL S ADV INJURY
$ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER
_
GENERALAGGREGATE
$ 2,000,000
POLICY`rX] EC 11 LOC
PRODUCTS -COMPJOP AGG
f 2, 000, 000
OTHER:
f
B
AUTOMDBILELUBOTTY
B,5D307091CNSS14
09/01/14
09/01/15
COMBINED SINGLE UMN
.IEaaccieem). _
S 1, 000, 000
X
ANY AUTO
BODILY INJURY (Per person)FALL
OWNED SCHEDULED
AUTOSNON<)WNED
BOOILYINOURY(Peramdmd)AUTOS
HIREDAUTOS X AUTOS
MOPERTYX
.lPm,acddmal)blVARGE
C
X
UMBRELLA LIAe
I %
OCCUR
4TSMCUP3C439373TIL14
09/01/14
09/01/15
EACHOCCURRENCE
2,00_0,000
_
AGGREGATE
_$
f 2, 000, 000
EXCESS UAB
CLAIMS-MADE
DEO X ENTI_ON_S 101000
RET
f
D
WORKERS COMPENSATION
AND EYPLOYERS'LIA&LnY YIN
ANY PROPRIETORMARTNERIEXECUTIVE
OFFICERIMEMBER EXCLUDED?
(Mmda"InPull
NIA
1063600
09/O1/16
09/01/15
% PER OTH-
---' STArurE.l ___ER
E.L.EACH ACCIDENT
--'
$ 1,000,000
E.L_DISEVSE-EAEMPLOY
--
f 11000,000
If yyeaaa desOi6eomko
DESCRIPTION OF OPERATIONS below
E.L. DISEASE -POLICY LIMIT
S 1, 000, 000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORO 101. AddNlonal Remd,s ScMdula, ma, ee allachad N mom cpace la nqulnd)
KVLUCK
of Port Collins
N. College Ave; P.O. Box 580
Collins, CO 80526-0000
1 USA
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
01988.2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
msamar
41311895