Loading...
HomeMy WebLinkAboutDIAMOND EXCAVATING INC - INSURANCE CERTIFICATE (6)DIAMEXC-01 SFORSBERG ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 116/2015 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 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 Forsberg Engerman Co 3575 S Sherman St Englewood, CO 80113 _ CONTACT Sarah Forsberg -Tripp q/CONNo Ezt : (303) 762-1717 n/c. No): (303) 762-1733 A E-MADRIESS: INSURER(S) AFFORDING COVERAGE NAIC# INSURER A:Cinci natl Insurance Companies 10677 INSURED Diamond Excavating Inc 5940 W 59th Ave Arvada, CO 80003 INSURER B:PinnaCOl Assurance 41190 INSURER C: INSURER D: INSURER E : INSURER F : C'OVFRAGFS 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 POLICY NUMBER MM/DDrrVYYY MM IDDrYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS -MADE a OCCUR X ENP0172168 01/07/2015 01/0712016 FIRM MIISES Ea occurrence $ 500,00 MED EXP (Any one person) $ 10,000 PERSONAL &ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,00 POLICY T JEST LOC PRODUCTS - COMP/OPAGG $ 2,000,00 $ OTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,00 BODILY INJURY (Per person) $ A X ANY AUTO ENP 0172168 01/07/2015 01/07/2016 ALL OWNED SCHEDULED AUTOS AUTOS NON-0WNED X N HIRED AUTOSAUTOS BODILY INJURY (Per accident) $ PR ERTY DAMAG Per accident $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,00 AGGREGATE $ 5,000,00 A EXCESS UAB CLAIMS -MADE ENP 0172168 01/07/2015 01/07/2016 DED I X I RETENTION$ 10,000 1 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE N❑ OFFICERIMEMBER EXCLUDED? (Mandatory In NH) N/A 2296640 04/0112014 04101/2015 X PER OTH- STATUTE ER E.L.EACH ACCIDENT $ 1,000,00 E. L. DISEASE - EA EMPLOYEE $ 1,000,00 If yes describe under DESCRIPTION OF OPERATIONS eeluw E.L. DISEASE - POLICY LIMIT • S 1,000,00 A Leased/Rented Equip ENP 0172168 01/07/2015 01/0712016 Limit 300,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Right of Way Contractor License The City of Fort Collins is named as additional insured with respect to general liability per form GA233CO 05111. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City Of Fort CollinsTHE y EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 580 Ft Collins, CO 80522-0580 AUTHORIZED REPRESENTATIVE � ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD