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Home My WebLink About389648 A-1 CHIPSEAL COMPANY - INSURANCE CERTIFICATE (11)A� �� CERTIFICATE OF LIABILITY INSURANCE TEm 9 30It014") 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: H 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 Moody Insurance Agency —Inc. .. -. 8055 East Tufts Avenue Suite 1000 - Denver CO 80237 CONTACT CathyBaker NAME: PNONE (303)824-6600 FAX f303)370-0118 No: _ZLULAA E-MAID cathy.baker®moodyins.com . INSURERS AFFORDING COVERAGE NAICN INSURERA:Phoenix Insurance Company 25623 INSURED A-1 Chipseal Company, DBA: Rocky Mountain 2001 West 64th Ln Denver CO 80221 INSURER B:Travelers Prop Cas Co of Amrca 25674 INSURER C:Pinnacol Assurance 41190 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. INSR LTR TYPE OF INSURANCE ADDL SUBR POLICYNUMBEfl POLICY EFF MMVDDMYYJ POLICY EXP IMMIGI LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 11000,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR X DTC0019OP673PHX14 0/1/2014 10/1/2015 PREMISES Ea occurrence $ 300,000 MED EXP (Any one person) $ 10,000 PERSONAL &AOV INJURY E 11000,000 GENERAL AGGREGATE $ 2, 000, 000 GEN% AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 7X POLICY PRO- LOC AUTOMOBILE LIABILIT - - COMBINED SINGLE LIMIT Eaaccident)_ 1,000,000 X BODILY INJURY(Per.persen) $ B B .ANY AUTO - _ ALL OWNED' SCHEDULED AUTOS AUTOS X' T810019OP673TIL19 - 0/1/2014 10/1/2015 I BODILY INJURY (Per accident) S NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Peraxklenl E MCS 90 Filing & Form F E X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10, 000, 000 B EXCESS LIAR CLAIMS -MADE DED X RETENTION$ 10,OOC $ DTSHCUP0190P673TIL14 10/1/2014 30/1/2015 C WORKERS COMPENSATION WC STATU- GTH- ANDEMPLOYERS'LIABILITY YIN E.L. EACH ACCIDENT E 500,000 ANY PROPRIETORIPARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) It yes, describe under DESCRIPTION OF OPERATIONS below N/A 055760 0/1/2014 0/1/2015 E.L. DISEASE-EAEMPLOYE $ 500,000 E.L. DISEASE -POLICY LIMIT E 500,000 IT DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (ANach ACORD 101, Additional Remarks Schedule, K more space is required) Re: Asphalt Surface Treatment Project --Renewal for Addition work Fall 2013 The City of Fort Collins is included as an Additional Insured with respect to General and Automobile Liability as required by written contract. City of Fort Collins 300 Laporte 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 ACORD 25 (2010/05) Baker/CATBAX O 1988-2010 ACORD CORPORATION. All rinhts raenrvad INS025 (201005).01 The ACORD name and logo are registered marks of ACORD '°`� b® CERTIFICATE OF LIABILITY INSURANCE 9/30/2014Yv> 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 THECERTIFICATEHOLDER. 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 Moody Insurance. Agency, Inc.. .- _-... ..._ BOSS East Tufts Avenue Suite 1000 _ Denver CO 80237 CNAMONTAOTE: Y Cath Baker " AX VHONE _1303)824-.6600 FA/C No: (303)370-0118 gh,'.acl;thy.baker@moodyins.com _ INSURERS AFFORDING COVERAGE NAICS INSURERA:Phoenix Insurance Company 5623 INSURED A-1 Chipseal Company, DBA: Rocky Mountain 2001 West 64th Ln Denver CO 80221 INSURERS:Travelers Prop Cas Co of Amrca 25674 INSURER C:Pinnacol Assurance 41190 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. INSR LTR TYPE OF INSURANCE ADDLSUBR POLICY NUMBER POLICY EFF MMMDNYYY) POLICY EXP (MMMDNYYYI LIMITS GENERAL LIABILITY EACH OCCURRENCE E 11000,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR X TC00190P673PH%14 0/1/2014 10/1/2015 DAMAGE To RENTED PREMISES Ea occurrence E 300,000 MED EXP (Any one Person) E 10,000 PERSONAL& ADV INJURY E 11000,000 GENERAL AGGREGATE E 2,000,000 - GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG E- 2,000,000 k X POLICY PRO-ECTLOG E -AUTOMOBILE LIABILRY (Ea accident) SINGLE LIMIT 1,000,00 X BODILY INJURY (Per. Person) E B ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS -X'- - T8100190P673TIL14 - 0/1/2014 0/1/2015 BODILY INJURY IPeraccidenQ -. .E NON -OWNED HIRED AUTOS AUTOS .... PROPERTY DAMAGE Per accident E MCS 90 Fi4n & Form F E X UMBRELLA LIAB X OCCUR EACH OCCURRENCE S AGGREGATE $ B EXCESS LIAB CLAIMS -MADE DIED X RETENTIONS 30100 E =50 TSMCUP0190P673TIL14 10/1/2014 10/1/2015 C WORKERS COMPENSATION WC STATU- DTH- AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOWPARTNER/EXECUTIVE❑ ER H)EXCLUDED? (Mandatory in (Mandetoryin and If yes, describe antler DESCRIPTION OF OPERATIONS below N/A 055760 10/1/2014 10/1/2015 E.L. EACH ACCIDENTOFFICERIMEM E E. L. DISEASE - EA EMPLOYE $ 500,000 E. L. DISEASE -POLICY LIMIT 1 E 500,000 7-T- DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Anach ACORD 101, Additional Remarks Schedule, it more space is required) Re: BID 7256 Hot Applied Chipseal Overlay--2013 Renewal The City of Fort Collins is included as an Additional Insured with respect to General and Automobile Liability as required by written contract. City of Fort Collins 300 Laporte 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 ACORD 25 (2010105) Baker/CATBAX C O 1988-2010 ACORD CORPORATION. All riahtR reserved- INS025 (201005).01 The ACORD name and logo are registered marks of ACORD