HomeMy WebLinkAbout224601 THOUTT BROS CONCRETE CONTRACTORS - INSURANCE CERTIFICATEACORD" CERTIFICATE OF LIABILITY INSURANCE
DATE(MMIODIYVVV)
0/2]/2014
PRODUCER
Pinnacol Assurance
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY
7501 E Lowry Blvd
Denver, CO 80230-7006
AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE
COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE NAIC#
INSURED
Thoutt Bros Concrete Contractors Inc
INSURER A'. Pinnacol Assurance
41190
INSURER B'.
5460 Tennyson St
Denver, CO 80212
INSURERC:
INSURER D:
INSURERE'
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDNG
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMMENT 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
ADD L
POLICY EFFECTIVE
POLICYE%PIRATION
LTR
INSRD
TYPE OF INSURANCE
POUCYNUMBER
DATEIMIWOO/YYYYI
OATE(MWDDMYY)
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
DAMAGE TO RENTED
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE OCCUR
PREMISES
MED E%P(Anyone Person
PERSONAL B AOV INJURY
GEN'L AGGREGATE LIMIT APPLIERS PER:
GENERAL AGGREGATE
PRODUCTS - COMPIOP AGO
POLICY PROJECTn LOC
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
ANY AUTO
(Ea APcdenl)
BODILYINJURY
ALL OWNED AUTOS
SCHEDULEDAUTOS
(Per Person)
BODILY INJURY
HIRED AUTOS
NON -OWNED AUTOS
(Per.... l)
PROPERTY DAMAGE
(Per..Menl)
GARAGE LIABILITY
AUTO ONLY EA ACCIDENT
OTHER THAN EA AGE
ANY AUTO
AUTO ONLY. AS
E%CESSNMBRELLA LIABILITY
EACH OCCURRENCE
AGGREGATE
OCCUR CLAIMS MADE
DEDUCTIBLE
RETENTION $
WORKERS COMPENSATION AND
WC STATU- OTHER
A
EMPLOYER'S LIABILITY
ANY PROPRIETORPARTNER/E%ECUTIVE
2033000
11/01/2014
11/01/2015
roar LIMITS
E.L EACH ACCIDENT
$t,ppp.ppp
OFFICER/MEMBER EXCLUDED?
EL DIBEABE - EA EMPLOYEE
$1,00 OW
It yea,Ne—:H-. uMar SPECIAL PROVISIONS Oebw
E.L DISEASE -POLICY LIMIT
I stmoe0o
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
CERTIFICATE HOLDER
CANCELLATION
1566391
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Fort Collins
THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
PO Box 580
MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
Fort Collins, CO 80522-0580
LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
Patricia Smith
ACORD 25(2001108)
Underwriter ACORD CORPORATION 1988
CERTIFICATE HOLDER COPY
City of Fort Collins
PO Box 580
Fort Collins, CO 80522-0580
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A
statement on this certificate does not confer rights to the certificate holder in lieu of such
endorsement(s).
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).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract
between the issuing insurer(s), authorized representative or producer, and the certificate
holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded
by the policies listed thereon.