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Home My WebLink AboutMETRO PAVERS INC - INSURANCE CERTIFICATE (5)QC R00 CERTIFICATE OF LIABILITY INSURANCE DATE(MWDD'YYYY) rv� 9/27/2018 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). F UCER CONTACT NAME: TrueNorth Risk Mgmt CSG-CO North PHONE Fax South Main Street, Ste 100 c 720-491-5411 C No:303-776 5495gmont CO 80502 E-MAILS certs truenorthcom anies.com INSURED Metro Pavers, Inc PO Box 601 Henderson CO 80640 METRPAV56 INSURER(S) AFFORDING COVERAGE INSURER A: Plnnacol Assurance Company NAIC0 41190 INSURER B United Fire & Casualt _Com an _ 13021 INSURER C Travelers Property Casualty Co of America 25674 INSURER D : INSURER E : CnVFRAGFS CFRTIFICATF NIJMRFR• lAr1R7rAA1 RFVI-RION NUMRFR 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 TYPE OF INSURANCE POLICY NUMBER —POLICY M DD'YYYY MM DD/YYYY LIMITS B X COMMERCIALGENERALLIABILITY Y 60496691 10,112018 10/1/2019 EACH OCCURRENCE_ $1.000,000 CLAIMS -MADE [ OCCURSESOEaEoNccTuErrDence $ 500.000 MED EXP (An one erson $ 5,000 j 1 PERSONAL 8 ADV INJURY -- $1,D00,000 -- ---- GEN'L AGGREGATE LIMIT APPLIES PER: I GENERAL AGGREGATE $ 2,000,000 y 7,PRO POLICY L ^ J' JECT I A j LOC ------- PRODUCTS - COMP.!OP AGG $ 2,000,OOD Prop Damaoe Dad $$500 OTHER: B AUTOMOBILE LIABILITY _ OD496691 10A 018 10/12019 COMBINED SINGLE LIMIT 1Ea accident $1 000000 BODILY INJURY (Per person) $ X : ANY AUTO i OWNED SCHEDULED AUTOS ONLY AUTOS X HIRED �( NON -OWNED AUTOS ONLY AUTOS ONLY w BODILY INJURY (Per accident) PROPERTY DAMAGE , Per accident) $ $ $ B C X UMBRELLA LIAB X OCCUR 60496691 ZUP31 M8611518NF 10/1/2018 10/1/2018 1011/2019 10M/2019 EACH OCCURRENCE _— $1_000,000 _ EXCESS LIAB CLAIMS -MADE AGGREGATE $1,000,000 DED X RETENTION � $ ._...__.___..___.,..._— A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETOR/PARTNER/ EXECUTIVE 'OFFICER�MEMBER EXCLUDED? (Mandatory In NH) N/A 4177329 10/1/2D18 10/1/2019 X PE OTH- E.L. EACH ACCIDENT $ 500.000 -- ---- E.L. DISEASE • EA EMPLOYEEI — — ----- $ 500,000 If yes, describe under I DESCRIPTION OF OPERATIONS below — E.L. DISEASE - POLICY LIMIT I $ 500,000 DESCRIPTION OF OPERATIONS r LOCATIONS i VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) If Yes is indicated above for add'I insd forms Gen Liab #CG7201 07/17, #CG7201 07/17(completed operations), Auto Liab #CA7109 01/17 applies. If Yes is indicated above for waiver of subrogation forms Gen Liab #CG7201 07/17. Auto Liab CA7109 01/17 and WC #WC000313 04/04 applies. Coverage is extended for work performed and required under written contract with the above named insured. If blanket coverage applies, state regulations limit the information that may be added regarding additional insureds to include policy form numbers only. City of Ft. Collins CO is named as additional as per written contract. CERTIFICATE HOLDEH 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. AUTHO IZED REPRESENTATIVE Ti 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD