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Home My WebLink AboutMETRO PAVERS INC - INSURANCE CERTIFICATE (4)ACORO® CERTIFICATE OF LIABILITY INSURANCE OATS IMMIDDII'YYY) 10/16/2014 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 endorsements . PRODUCER TrueNorth 275 South Main Street, Ste 100 Longmont CO 80502 NAMTAc TmeNorth Risk M mt CSG-CO PHONE 720-491.5411 C. . 303-776-5495 Ms.. certs@truenorthcompanies.com INSURE S AFFORDING COVERAGE NAICIf INSURER A:Westfield Insurance Company 24112 INSURED METRPAV-06 INSURER B:PinnacolAssurance Company 41190 Metro Pavers, Inc PO Box 601 INSURER C: Henderson CO 80640 INSURER D: INSURER E : INSURER F COVERAGES CERTIFICATE NUMRFR- 1565408511 RPVIS:InN NI IMRFR. 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 I TYPE OF INSURANCE ADDL INSD SUBR VIVO POLICY NUMBER POLICY EFF IMMI)n(Y11n POLICYEXP IMI LIMITS A X COMMERCIAL GENERAL LMBIUW EMM1987696 10/1/2014 10/l/2015 EACH OCCURRENCE $1,000,000 CLAIMS -MADE 1XI OCCUR DAMA N ED PREMISES Ea occurrence $500,000 MED EXP(Any one Person) $5.000 PERSONAL B ADV INJURY S1,000,000 AGGREGATE LIMIT APPLIES PER. POLICY JECT [�] LOC GENERAL AGGREGATE $2,0001000 GEN'L PRODUCTS - COMP/OP ADD $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY CMM1987696 10/1/2014 10/1/2015 EMNNIent $1,000,000 X BODILY INJURY (Per person) $ ANY AUTO AUTOSMED AUTOS BODILY INJURY (Per accident $ X HIRED AUTOS X NON-OMED AUTOS PR R—WDAMA -E Per acddenl $ $ A X UMBRELLA LIAR X OCCUR CMM1987696 10/1/2014 10/1/2015 EACH OCCURRENCE $10,000,000 I AGGREGATE $10,000,000 EXCESS UAB ICLAIMS-MADE DELI I X I RETENTION$0 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILIW YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED' NIA 4177329 10/1/2014 10/1/2015 PER OTH- 'x STATUTE ER EL EACH ACCIDENT $500,000 E.L. DISEASE -EA EMPLOYE $500,000 (Mandatary In NH) If yes, descn0e under EL. DISEASE -POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS... DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Add"dional Rema s ScWdule, my b attached U more space is mquimdl If Yes is indicated above for add'I insd forms Gen Liab #CG7137 11/12 (premises), #CG2037 04/13 (completed operations), Auto Liab #CA7077 09/11 applies. If Yes is indicated above for waiver of subrogation forms Gen Liab #CG7137 11/12. Auto Liab CA0444 03/10 and WC #WC000313 04/04 applies. Coverage is extended for work performed and required under written contract with the above named insured. City of Fort Collins PO Box 580 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. AUTOO ED REPRESENTATIVE CORPORATION. All rinhts reeervnd ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD