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Home My WebLink About353928 CONCRETE STABILIZATION TECHNOLOGIES INC - INSURANCE CERTIFICATE (5)Client#: 1084369 CONCRSTA ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 1212912014 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: USI Colorado, LLC C/L PAHIO NNo Eat:800 873-8500 tFAx AC No: 1515 Wynkoop Street E-MAIL ADDREss: den.contractors@usi.biz Suite 200 Denver, CO 80202 INSURER(S) AFFORDING COVERAGE NAIL If INSURER A: United Specialty Insurance Comp 12537 INSURED INSURER B: Plnnacol Assurance Company 41190 Concrete Stabilization Technologies,lnc INsuRERc: Cincinnati Insurance Company 10677 8500 E. Warren Avenue Denver, CO 80231 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 CONTRACTOR 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 UpINSR TYPE OF INSURANCE ADD L SUB WVD POLICY NUMBER POLICY EFF MM/DD POLICY UP MM/DD LIMITS A GENERAL LIABILITY BV01573201 1/01/2015 01/01/201f $1000000 X COMMERCIAL GENERAL LIABILITY ppEAAqCCry�tHHqOECCURRENCE PREMISES Ea NT. ence $50 DDD CLAIM. -MADE r_X] OCCUR MED UP (Any one person) $ N/A PERSONAL& ADV INJURY $1,000,000 X BI/PD Dad: $25,000 GENERAL AGGREGATE s2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO $2,000,000 POLICY X jR� LOC $ C AUTOMOBILE LIABILITY EPP0173576 1/01/2015 01/01/201 COMBINED SINGLE LIMIT Eaacciderd 1,000,000 X BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY Peractltlent ( ) $ X HIRED AUTOS X NON -OWNED AUTOS PROPERTY DAMAGE Per accident $ A UMBRELLA LIAB X OCCUR BU01553178 1101/201501/01/201 EACH OCCURRENCE s2000000 X AGGREGATE s2,000,000 EXCESS LWB CLAIMS -MADE DED RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? N/A 4121092 1/01/2015 01/0112016 X WC STATU- OTH. E.L. EACH ACCIDENT s5000OO E.L. DISEASE- EA EMPLOYEE $500 000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE- POLICY LIMIT $500,000 A Stop Gap BV01573201 1/01/2015 01/011201 Ea Accident $1,000,000 Employer Liab. WY Ea Employee $1,000,000 A re ate $1 000 000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) As required by written contract or written agreement, the following provisions apply subject to the policy terms, conditions, limitations and exclusions: the Certificate Holder is included as Additional Insured for work, acts or omissions under the General Liability and Automobile Liability but only with respect to liability arising out of the Named Insured's work performed on behalf of the certificate holder. City of Fort Collins PO Box 580 Ft Collins, CO 80522-0000 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) 1 of 1 $q 1do TiRnAIIM4dMgAnR (40Y (01983.2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD TYMRr