Loading...
HomeMy WebLinkAbout103166 ZAK DIRT - INSURANCE CERTIFICATEACORD CERTIFICATE OF LIABILITY INSURANCE rm DATE 12/2014 09/12/2014 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 CONTACT NAME: Renee McReynolds Ewing -Leavitt Insurance Agency 4025 St. Cloud Dr. Pa"c°ONOE,t:970.679.7344 ".:866.425.6180 ADDREss: renee-mcreynolds@leavitt.com Suite 100 INSURER(S) AFFORDING COVERAGE NAICIs Loveland, CO 80538 INSURER A: Cincinnati Insurance Co 10677 INSURED Zak Dirt, Inc. �U2 ,I ,. INSURERB: Plnnacol Assurance 41190 14290 Hilltop Road J �X INSURERC: Longmont, CO 80504 INSURER D: INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 14-15' 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. LTR TYPE OF INSURANCE INSR WVD POLICYNUMBER MMIEDITYYY fI$f/DD/1'1'YY LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE [­X� OCCUR X Blkt Addl Insureds CPP108410610101/2014 10/01/2015 EACH OCCURRENCE $ 1,000,00 ,IN 111 PREMISES Ea ocCunence S 500,000 MED EXP (Anyone person) $ 5,00 PERSONAL$ADV INJURY $ 1,000,00 X Blkt WOS GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PRO El LOC ECT PRODUCTS-COMP/OP ADD $ 2,000,00 $ A AUTOMOBILE UABIUTY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS X NON -OWNED AUTOS Blkt AI. X Blkt wOS CPP108410 10/01/2014 10/01/2015 Eaacadent $ 1,000,00 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ X Per accident $ X omp/Coll $ 1000 de A 1( UMBRELLA UAB EXCESS UAB X OCCUR CLAIMS -MADE CPP108410 10/01/2014 10/01/2015 EACHOCCURRENCE $ 5,000,00 AGGREGATE $ 5,000,00( LIED X RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABIUTY ANY PROPRIIMBEREXCLNER]E YIN N ECUTIVf❑ OFF(Mandatory In NH) II es, desaiee under DESCRIPTION OF OPERATIONSI1elms NIA 84662 INCL BLANKET WAIVE OF SUBROGATION 10101/2014 10/01/2015 X TORY LIMITS ER E.L. EACH ACCIDENT $ 500,00 E.L. DISEASE -EA EMPLOYE $ 500,00 E.L. DISEASE -POLICY LIMIT $ 500,00 A ontractors' Equipment - Installation Floater $50,000 CPPI08410 10/01/2014 10/01/2015 $500,000 limit Leased/Rented Equipment subject to $1,000 ded DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORO 101, Additional Remarks Schedule, if more space is re ulred) e: N College Improvements Project - Conifer to Willox, Job #STE M455-106/7673 ertificate holder and Colorado Department of Transporation are named additional insured under oth the general and auto liability policies. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Fort Collins Purchasing Div AUTHORIZED REPRESENTATIVE P 0 Box 580('�1 Fort Collins, CO 80522 Renee McRe nolds/RESTEI ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD ACORD. CERTIFICATE OF LIABILITY INSURANCE T2/2014 YYY DATE ( 09/12/2014 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 Ewing -Leavitt Insurance Agency 4025 St. Cloud Dr. Suite 100 Loveland, CO 80538 CONTACT NAME: Renee McReynolds FAX aco.N E.t:970.679.7344 ac,Np:866.425.6180 AODREss: renee-mcreynolds@leavitt.com INSURER(S) AFFORDING COVERAGE NAIC0 INSURER A: Cincinnati Insurance Co 10677 INSURED Zak Dirt, Inc. 14290 Hilltop Road Longmont, CO 80504 INSURERB: Plnnacol Assurance 41190 INSURER C: INSURER D: INSURER E : INSURER F: COVERAGES CERTIFICATE NUMBER: 14-15 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. LTR TYPE OF INSURANCE INSR MD POLICY NUMBER MMIDDIYYYY MMIDDIYYYY LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS-MADE[XI OCCUR X Blkt Addl Insureds CPPI084106 10/01/2014 10101/2015 EACH OCCURRENCE $ 1,000,00 PREMISES JEa occurrence $ S00,00 MED EXP (My one person) $ 5,00 PERSONAL& ADV INJURY $ 1,000,000 X Bl kt WOS GENERAL AGGREGATE $ 2, 000, 000 APPLIES PER: GENL AGGREGATE LIMIT JECT POLICY X PRO- LOC PRODUCTS-COMP/OP AGO $ 2,000,00 $ A AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS X HIRED AUTOS J( NON -OWNED AUTOS X Blkt AI X Blkt w0S CPP1084106 10101/2014 10/01/2015 Ea accident $ 1,000,00 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ Per accident $ omp/Coll $ 1000 de A X UMBRELLA UAB EXCESS LIAR X OCCUR CLAIMS -MADE CPPI084106 1010112014 10/0112015 EACH OCCURRENCE $ S,000,00 AGGREGATE $ S,000,00( DED X I RETENTION $ 0 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVEF OFFICER)MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N I A 84662 INCL BLANKET WAIVERE.L. OF SUBROGATION 10ro112014 10101/2015 x TORY LIMITS ER EACH ACCIDENT $ SOO,OO E.L. DISEASE - EA EMPLOYE $ S00500 E.L. DISEASE -POLICY LIMIT $ 500,000 A ontractors' Equipment - Installation Floater $50,000 CPP108410 10/01/2014 10101/2015 $500,000 limit Leased/Rented Equipment subject to $1,000 ded DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101. Additional Remarks Schedule, If more space Is required) e: 7558 Arthur Ditch CBC Replacement at Mountain Ave & Myrtle Street he City of Fort Collins is named as additional insured on both GL/Auto liability policies as respects work performed. City of Fort Collins 21S N Mason St Fort Collins, CO 80522 IiNIY{, CLLN I ILIN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD ACORD CERTIFICATE OF LIABILITY INSURANCE TN DATE (MMIDDM YY) 09/12/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Ewing -Leavitt Insurance Agency 402S St. Cloud Dr. Suite 100 Loveland, CO 80538 CONTANAME: Renee McReynolds PHONE 970.679.7344 866.425.6180 AIC No : A/C, No ADDRESS:Ext renee-mcreynolds@leaviit.Com INSURER($) AFFORDING COVERAGE NAIC0 INSURER A: Cincinnati Insurance Co 10677 INSURED Zak Dirt, Inc. 14290 Hilltop Road Longmont, CO 80504 INSURER8: Pinnacol Assurance 41190 INSURERC: INSURER D: INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 14-15 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. LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MMIDDIYYYY MMIDDIYYYV LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS-MADE I -XI OCCUR X Blkt Addl Insureds CPPI084106 10/01/2014 10/01/2015 EACH OCCURRENCE $ 1,000,00 PREMISES Es occurrence $ 500,00 MED EXP (Any one person) $ 5,00 PERSONAL &ADV INJURY $ 1,000,00 X Bl kt WOS GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X JERC JECT OC PRODUCTS - COMP/OP AGG $ 2,000,00 $ A AUTOMOBILE LIABILITY ANY AUTO AL WNED SCHEDULED AULTOOS AUTOS HIRED AUTOSX NONOWNEO AUTOS Blkt AI X Blkt WOS CPP108410 10/0112014 10/01/2015 Ea accident $ 1,000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ X Per accident $ X omp/Coll $ 1000 de A X UMBRELLA LIAR EXCESS UI B X OCCUR CLAIMS -MADE CPP108410 10/01/2014 10/01/2015 EACH OCCURRENCE $ 5,000,00( AGGREGATE $ 5,000,00( DIEDRETENTION$ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N OFFICER/MEMBER EXCLUDED ECUTIVF�I (Mandatory In NH) u If yes, describe under DESCRIPTION OF OPERATIONS EeIow NIA 84662 INCL BLANKET WAIVE OF SUBROGATION 10101I2014 10101/2015 X TORY LIMITS ER E.L. EACH ACCIDENT $ 500,00 E.L. DISEASE EA EMPLOYEE $ 500,00 E. L. DISEASE -POLICY IT $ $QQ, QQ A __M ontractors' Equipment - Installation Floater $50,000 CPP108410 10/0'1/2014 '10/0112015 $500,000 limit Leased/Rented Equipment subject to $1,000 ded DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Atbch ACORD 101, Addibonal Remarks Schedule, If more space Is recIulred) e: Shields & Laporte, Fort Collins, CO #314.12 he City of Fort Collins and Colorado Department of Transportation are named as additional insureds as respects work performed. CERTIFICATE HOLDER CANCELLATION City of Fort Collins 215 N Mason St Fort Collins, CO 8OS22 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROwSIONS. AUTHORIZED ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD ACORD,. CERTIFICATE OF LIABILITY INSURANCE .2/2014 (MMMDffyy DATE 09/12/2014 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 Ewing -Leavitt Insurance Agency 4025 St. Cloud Dr. Suite 100 Loveland, CO 90538 CONTACT NAME: Renee McReynolds Pn"c°NU Eat:970.679.7344 AIC,Np:866.425.6180 AooResS. renee-nee INSURER(S) AFFORDING COVERAGE NAIC0 INSURER A: Cincinnati Insurance Co 10677 INSURED Zak Dirt, Inc. 14290 Hilltop Road Longmont, CO 80504 INSURER : Pinnacol Assurance - 41190 INSURER C: INSURER D: INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 14-15 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. LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MMIDDIYYYY MMIDDIYYYY LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL UABILRY CLAIMS -MADE a OCCUR X Blkt Addl Insureds CPPI084106 10/01/2014 10/01/2015 EACH OCCURRENCE $ 1,000,000 ENTED— PREMISES Ea oboumence $ S00, OD MED EXP (Any we person) $ S,OD PERSONAL BADVINJURY $ 1,000,00 X Bl kt WOS GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY )CI JEPRCTO LOC PRODUCTS -COMPIOP AGG $ 2,000,00 $ A AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS X HIREDAUTOS X NON -OWNED AUTOS X Blkt AI X Blkt WOS CPP108410 10101/2014 10/01/2015 11,111 Ea accident $ 1,000,00 BODILY INJURY(Per person) $ BODILY INJURY (Per accident) $ Per accident omp/Coll $ 1000 de A X UMBRELLA UAB E%CESS LIAB X OCCUR CLAIMS -MADE CPP108410 1010112014 10/01/2015 EACH OCCURRENCE $ 5,000,00( AGGREGATE $ 5,000,00( OEO X RETENTION$ C $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVSI�YINI OFFICERIMEMBER EXCLUDED? u (Mandatory In NH) If Yes, describe under DESCRIPTION OF OPERATIONS below N I A 846620 INCL BLANKET WAIVE OF SLIBROGATION 10/0112014 10101/2015 X W TORV LIMITS ER E.L. EACH ACCIDENT $ 500,00 E.L. DISEASE - EA EMPLOYEE $ SOO, 0U E.L. DISEASE -POLICY LIMIT $ 500,00 A ontractors' Equipment - Installation Floater $50,000 CPP108410 10/01/2014 1010112015 $S00,000 limit Leased/Rented Equipment subject to $1,000 ded DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space m redIulred) e: Bryan Avenue Bridge Replacement, Project No BRO M455-092 The City of Fort Collins, Colo Dept of Transportation and Larimer County Canal No. 2 are named s additional insureds as respects work performed and as respects both general and auto liability. CERTIFICATE HOLDER CANCELLATION City of Fort Collins 215 N Mason St 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 Renee i 11:I:197fi BL•\Ke] N BIKe]:71e].TA ire] ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD