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HomeMy WebLinkAboutBACKHOE EXCAVATING INC - INSURANCE CERTIFICATEACC>R" CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD YYYY) lei" 1 9/6/2018 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 have ADDITIONAL INSURED provisions or 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: Daniel Gamero Brown & Brown Insurance of AZ, Inc PHONE FAX 2800 N. Central Ave., #1100 Arc No Ext : 602-494-6781 A c No : 602-287-6784 P.O. Box 2800 nooRess: dgamero@bbphoenix.com Phoenix AZ 85004 INCI IRPPIC1 APPr1Pr11rdP CflVPPAGP Ne1C f! INSURER A: United Specialty Insurance Company 12537 INSURED BACKEXC-01 INSURER B: Ohio Security Ins Co 24082 Backhoe Excavating, Inc. INSURERC: Argonaut Great Central Insurance Co 19860 P.O. Box 12 Firestone CO 80520 INSURERD: Federal Insurance Company 20281 INSURER E : COVERAGES CERTIFICATE NUMBER: 547n19764 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. IPOLICY NSIRIN LTR TYPE OF INSURANCE IADDLSUBR POLICY NUMBER MMDDIYPOLICYEYYY) EXP 1MM/DDNYYY1 LIMITS A X COMMERCIAL GENERAL LIABILITY Y ATN-SF1853181 9/5/2018 9/5/2019 EACH OCCURRENCE $1,000,000 F v� CLAIMS -MADE OCCUR DAMAGE TO RENTED— PREMISES Ea occurrence $50,ODO X MED EXP (Any one person) $ 5,000 ded - $10,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY I X I PECOT- LOC PRODUCTS - COMP/OP AGG $ 2,000.000 $ OTHER: B AUTOMOBILE LIABILITY BAS57824082 9/5/2018 9/5/2019 COEaMB acciINED dentdents NGLE LIMIT $ 1,000,000 BODILY INJURY (Per person) $ X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY $ A UMBRELLA LIAB X OCCUR BTN1864861 9/5/2018 9/5/2019 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 X EXCESS LIAB CLAIMS -MADE DED I X I RETENTION $ 0 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN WC 928408668684 7/1/2018 7/1/2019 X PER OTH- STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? a N/A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,000 T yes, describe under DESCRIPTION OF OPERATIONS below - - E.L. DISEASE - POLICY LIMIT - $ 1,000,000 D Equipment 0670-45-31 WCE 9/5/2018 9/5/2019 Owned equipment 1,439.126 Ded-$1,000 Leased, rented, 200, DOD borrowed DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Subject to policy terms, conditions, limitations and exclusions. %,r-m I Ir m,/A I C nULUCr[ VMIY \.CLLH I IUIY JV uay� City of Fort Collins Attn: Engineering Department 281 N. College Ave Fort Collins CO 80524 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 REPRESIINTATIVE © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable For an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule Blanket Waiver of Subrogation Colorado This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective Date:07/01/2018 Policy No. TnIC 928108668684 Endorsement No. Policy Effective Date: 07/01/2018 to 07/01/2013 Premium $ Insured: Backhoe Excavating, Inc. DBA: Carrier Name! Code: Argonaut Insurance Company WC 00 03 13 Countersigned by (Ed. 4-84) E' 1983 Natlonal Council on Compensation Insurance. Page 1 Of 1