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HomeMy WebLinkAboutADVANCED UNDERGROUND INC - INSURANCE CERTIFICATE (3)ADVA-11 OP ID: SJR CERTIFICATE OF LIABILITY INSURANCE D0113012015ATE ) 01/30/2015 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 polities may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsements . PRODUCER CRS Insurance Brokerage Commercial Risk Solutions DBA 6600 E. Hampden Ave. Denver, CO 80224 CCO jTACT Eric Johnson, CIC PHONE 303-996-7801 FAX ac No Eat : Arc No): 303-757-7719 E-MAIL ADDRESS: INSURE S AFFORDING COVERAGE NAIL# Erie Johnson, CIC INSURER": Westfield Insurance 24112 INSURED Advanced Underground, Inc. INSURER B: Pinnacol Assurance Frontier Underground, LLC 10360 East 107th Place INSURER Westchester Fire Ins. Co. INSURER 0: Brighton, CO 80601 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 INSURANCEADDL BUSH POLICY NUMBER POLICY EFF MMM POLICY EXP MMIDD LIMITS A X COMMERCIAL GENERAL LU181LTIY CLAIMS-MADE T OCCUR X CMM0830976 01/05/2015 01/0612016 EACH OCCURRENCE E 1,000,00 PREMISES ESOcanence $ 600,00 MED EXP (Any we person) S 5,00 PERSONAL S ADV INJURY S 1,000,0001 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY JEC LOC GENERAL AGGREGATE S 2,000,0010 PRODUCTS - COMPIOP AGO E 2,000,0011 S OTHER: AUTOMOBILE LU1BILnY COMBINED SINGLE LIMIT Ea accident E 1,000,00 X BODILY INJURY (Per peson) $ A ANY AUTO CMMOS30976 01105/2015 01/0612016 "CLOWNED SCHEDULED AUTOS AUTOS BODILY INJURY Per acodent ( i S HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE Per Bccidenl $ E J( 4 UMBRELLA LIAB X OCCUR EACH OCCURRENCE S 6,000,00 AGGREGATE s 6,000,00 A EX EBB LIAR CLAA1S-MADE CMMOS30976 01/05/2015 01/05/2016 DED I X I RETENTIONS 0 i B WORKERS COMPENSATION AND EMPLOYERS LIABILITY ANY PROPRIETORIPARTNEREXECUTIVE Y//NN OFFICER/MEMBER EXCLUDED? NIA 076345 01101/2016 01/01/2016 OTH- X STATUTE ER E.L. EACH ACCIDENT S 1,000,00 E.L. DISEASE - EA EMPLOYEE $ 1,000,00 (Mandatory in NH) K yyea, desuibe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT S 1,000,00 C Pollution Liab. G2762865A 10/31/2014 1013112015 Ea Claim 1,000,00 A Inland Marine CMM0830976 01/05/2015 01/05/2016 Rntd/Lsd 100,00 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES IACORD 101, Addilonal Remerks Schedule, may be eKachad It more space Is required) 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. ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD