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Home My WebLink AboutBORNHOFT EXCAVATING INC - INSURANCE CERTIFICATEACORO® CC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY) 12/01/2018 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 Javier Perez NAME: Flood and Peterson PHONE (970) 356-0123 FAX (970) 330-1867 A/C No Ext : A/C, No : PO Box 578 E-MAIL JPerez@FloodPeterson.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: National Builders Insurance Company 16632 Greeley CO 80632 INSURED INSURER B : Westfield Insurance Company 24112 INSURER C : Pinnacol Assurance 41190 Bornhoft Excavating, Inc. INSURER D : 11319 Weld County Rd 72 INSURER E : Eaton CO 80615 INSURER F : COVERAGES CERTIFICATE NUMBER: CL1812326456 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 CONTRACTOR 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. ILTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDDIYYYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 �/ CLAIMS -MADE X OCCUR A PREMISES Ea occurrence 100.00�0 $ MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 A Y PKG023372901 03/01/2018 03/01/2019 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY JECT PRO ❑ LOC PRODUCTS-COMP/OP AGG $ 2,000,000 Employee Benefits $ 1,000,000 OTHER: I AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 X BODILY INJURY (Per person) $ ANYAUTO B OWNED SCHEDULED AUTOS ONLY AUTOS Y CWP5247671 03/01/2018 03/01/2019 BODILY INJURY (Per accident) $ X PROPERTY DAMAGE Per accident $ HIRED HNON-OWNED AUTOS ONLY AUTOS ONLY Uninsured motorist $ 1,000,000 UMBRELLA LIAR OCCUR V "" "6" "U �"'y" """' EACH OCCURRENCE $ HCLAIMS-MADE AGGREGATE $ EXCESS LIAB DED I I RETENTION $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE FV1 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) NIA 4179206 12/01/2018 12/01/2019 X STATUTE �RH E.L. EACH ACCIDENT 1,000,000 $ E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Fort Collins is included as Additional Insured as required by written contract with respects to liability arising out of work performed by the named insured. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Fort Collins Attn: Connie Kiehn ACCORDANCE WITH THE POLICY PROVISIONS. 281 N College Ave AUTHORIZED REPRESENTATIVE Fort Collins CO 80521 Y @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD