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Home My WebLink AboutADVANCED UNDERGROUND INC - INSURANCE CERTIFICATE (2)ADVA-11 OP ID: SJR .4. 4 ' CERTIFICATE OF LIABILITY INSURANCE `� D121182 Y4 12/16/2014 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 . PROOUCER CRS Insurance Brokerage Commercial Risk Solutions DBA CONTACT Eric Johnson, CIC E. PHONE 303-996-7801 FAX No: 303-757-7719 A/C No Ert:JAPC, 6600 E. Hampden Ave. Denver, CO 80224 E#1AIL ADDRESS: Eric Johnson, CIC INSURERS AFFORDING COVERAGE NAIC 0 INSURER A: Westfield Insurance 24112 INSURED Advanced Underground, Inc. INSURERS: PInnacol Assurance Advanced Underground Services 10360 East 107th Place INSURERC: Westchester Fire Ins. Co. Brighton, CO 80601 INSURER D : INSURER E : INSURER F: COVERAGES CERTIFICATE NUMBER: 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 DL SUERPOLICY POLICY NUMBER EFF MMIDD/YYYY POLICY EXP MWDDIYYYYT LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS -MADE XOCCUR X CMM0830976 01I05/2015 01/05I2016 PREMISES Ea occurrence $ 500,00 ME EXP (Any one person) $ 6,00 PERSONAL B AOV INJURY $ 1,000,00 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 POLICY JEo LOC PRODUCTS-COMPIOPAGG S 2,000,00 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea sodden $ 1,000,00 X BODILY INJURY (Per person) $ A ANY AUTO CMM0830976 01/05/2015 0110512016 ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per amident) $ PROPERTY DAMAGE Peramdent S NON -OWNED HIRED AUTOS qAUTOS X I UMBRELLA UAB X OCCUR EACH OCCURRENCE $ 5,000,00 AGGREGATE $ 5,000,00 A EXCESS LIAR CLAIMS -MADE CMM0830976 0110512015 01105/2016 DED X RETENTIONS 0 $ B WORKERS COMPENSATION - AND EMPLOYERS' LIABILITY ANY PROPRIETORRARTNER/EXECUTIVE YIN OFFICER/MEMBEH EXCLUOEDT FT] (Mandatory in NH) NIA 4076345 01/01/2015 01/0112016 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE -EA EMPLOYEE $ 1,000,09 It yyea describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT I $ 1,000,00 C Pollution Liab. G2752865A 10/3112014 1/113112015 Ea Claim 1,000,00 A Inland Marine CMM0830976 01/05/2015 01/0612016 Rntd/Lsd 100,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Reroarh Schedule, mry W attached If room apaoo la rpoirod) City of Fort Collins is included as additional insured on the General Liability with respect to ongoing operations of the named insured for the certificate holder as required by written contract. All policy terms, conditions and exclusions apply. CITYFTC 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. AUTHOOWED REPRESENTATIVE 01983-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD