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Home My WebLink About389648 A-1 CHIPSEAL COMPANY - INSURANCE CERTIFICATE (12)A�ORO® CERTIFICATE OF LIABILITY INSURANCE DATE(MY) 01 / 10//2019 019 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 Deanna Zahn, ACSR NAME: Moody Insurance Agency, Inc. n/C No. (303) 824-6600 FAX (303) 370-0118 E:t : No : 8055 East Tufts Avenue E-MAIL deanna.zahn@moodyins.com ADDRESS: Suite 1000 INSURER(S) AFFORDING COVERAGE NAIC # Denver CO 80237 INSURERA: Phoenix Insurance Company 25623 INSURED INSURER B: Travelers Indemnity CO 25658 A-1 Chipseal Company, DBA: Rocky Mountain Pavement, LLC INSURER c : Pinnacol Assurance 41190 2505 E. 74th Ave INSURER D : Illinois Union Insurance Company 27960 INSURER E Denver CO 80229 INSURER F COVERAGES CERTIFICATE NUMBER: 19-20 Master 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 INSD WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTE PREMISES Ea occurrence 300,000 $ MED EXP (Any one person) $ 10,000 PERSONAL BADVINJURY $ 1,000,000 A Y DTCOOJ730005PHX19 02/01/2019 02/01/2020 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY � PRO JECT LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS-COMP/OP AGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 X BODILY INJURY (Per person) $ ANY AUTO B OWNED SCHEDULED AUTOS ONLY AUTOS Y DT8103L405197TIL19 02/01/2019 02/01/2020 BODILY INJURY (Per accident) $ HIRED NON -OWNED AUTOS ONLY X AUTOS ONLY X PROPERTY DAMAGE Per accident) ccident $ $ X UMBRELLA LIAB —[OCCUR EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10,000,000 B EXCESS LIAB rl CLAIMS -MADE CUP2J3100431926 02/01/2019 02/01/2020 DED I X1 RETENTION $ 10,000 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA 4055760 02/01/2019 02/01l2020 PER OTH- X STATUTE ER E.L. EACH ACCIDENT $ SOO,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 E.L. DISEASE - POLICY LIMIT $ 500,000 D Pollution Liability CPYG27165825007 02/01/2019 02/01/2020 Per Pollution Condition Aggregate Limit 5,000,000 5,000,000 Deductible 25,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) GANGtLLAI IUN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 580 AUTHORIZED REPRESENTATIVE Fort Collins CO 80522 @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD