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HomeMy WebLinkAboutTROY FORMING CONCRETE INC - INSURANCE CERTIFICATE (3)CERTIFICATE OF LIABILITY INSURANCE DATE (MWDD/YYYY)4/1/2015 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 CONTACT Sandra Thomas, CIC NAME: Moody Insurance Agency, Inc. JAIL NEo_E (303)824-6600 (ACC Noo(303)370-0118 8055 East Tufts Avenue nDDRES:sthomas@moodyins.com Suite 1000 INSURERS AFFORDING COVERAGE NAN:f Denver CO 80237 INSURERA:Rni ht Specialty Insurance Contp=15366 In" new INSURER B:American Select Insurance Co 19992 Troy Forming Concrete, Inc. INSURERC:Pinnacol Assurance 41190 Denver Caisson Drilling, Inc. INSURERD: 998 Salida Way INSURER E: Aurora CO 80011 INSURER F: COVFRAGFR CFRTIFICATF NIIII RFtnclnKI 1,1111WIRIZo- 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. INSIRTR TYPE OF INSURANCE AD L U POLICY NUMBER POLICY EYY MM/DD/YYYY LIMITS A % COMMERCIAL GENERAL LIABILITY CLAIMS -MADE �8 OCCUR KSVEMA150006400 4/1/2015 4/1/2016 EACH OCCURRENCE $ 11000,000 DAMAGE 0 NTED PREMISES s occurrence $ 50, 000 MEDEXP (Any one person $ Bscluded PERSONAL B ADV INJURY S 11000,000 GENT AGGREGATE LIMIT APPLIES PER: POLICY ® PEA LOC OTHER: GENERAL AGGREGATE S 21000,000 PRODUCTS - COMP/OP AGG S 2,000,000 Per Prof Agg Limit 5 S See End 8 AUTOMOBILE LIABILITY ANY AUTO SCHEDULED ALL OS NON -OWNED HIRED AUTOS AUTOS CM0784429 4/1/2015 4/1/2016 CEOMBINED SINGLE LIMIT a accident) f 11000,000 BODILY INJURY (Per person) S I BODILY INJURY (Pat accident) S eNED PROPERTYDAMAGE ES ident Medical Davments S 5,000 UMBRELLA LIAB EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ S C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERWEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA 4103394 4/1/2015 4/1/2016 $ O - STATUTE R E.L. EACH ACCIDENT $ - 1,000,000 E.L. DISEASE - EA EMPLOYEE S 1,000,000 E.L. DISEASE- POLICY LIMIT f 1.000.000 I DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101. Additional Remarks Schedule, may be attached if more space is required) vLrl VNIY{..CLLN I IVI\ City of Fort Collins P.O. Box 580 Fort Collins, CO 80521 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 S Thomas, CIC/SANTHO ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (201401)