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HomeMy WebLinkAboutROBERTS EXCAVATION CORPORATION - INSURANCE CERTIFICATE (12)ROBEEXC-01 MTUSINSKI ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MM DD VYI V) 411412015 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 CONTANAME, Debbie McGee TrueNorth PHONE 303 776-5122 FAX PO Box 847 (Al No Ertl:( ) (A/C, No): (303) 776-5495 Longmont, CO 80502 E-MAIL ESS: dmcgee@truenorthcompanies.com INSURED Roberts Excavation Corp. 1801 1st. St Berthoud, CO 80513 E: AFFORDING COVERAGE NAIC0 Insurance Comnanv 124112 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. INSIR TYPE OF INSURANCE ADDIL POLICY NUMBER POLICY EFF POLICY EXPLTR L001TE A X COMMERCIAL GENERALLLIBNJTY CLAIMS -MADE aOCCUR TRA3889121 04/01/2015 EACH OCCURRENCE 04/01/2016 DAMAGE TO RENTED PREMISES (Ea occurrence) MED EXP (Any one person) PERSONAL B ADV INJURY GENERAL AGGREGATE PRODUCTS -COMPIOPAGG S 1,000,00 S 100,00 $ 10,00 S 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY T JEg LOC OTHER: $ 2,000,00 S 2,000,00 $ AUTOMOBILE LIABILITY A X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS TRA3889121 04101/2015 04101/2016 MBINED SINGLE LIMIT Ea acdtlent g 1 00O 0O r r BODILY INJURY (Per person) S BODILY INJURY (Per er accident) $ $ _ S PROPERTY DAMA E Par accident X UMBRELLA LIAB X OCCUR A EXCESS LIAR 1 CLAIMS -MADE DIED X RETENTIONS 10,000 TPA3M121 04/01/2015 04/0112016 EACHOCCURRENCE S 1,000,00 $ 1,000,00 $ AGGREGATE WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE ❑NIA OFFICER/MEMBER EXCLUDED? (Mandatory in NH) if yes, describe under DESCRIPTION OF OPERATIONS below I PER TH- STATUTE ER S - $ S E.L EACH ACCIDENT E.L. DISEASE - EA EMPLOYE E.L. DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) l9aC\all P)1\ate City of Fort Collins 215 N Mason St 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 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD