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HomeMy WebLinkAbout353928 CONCRETE STABILIZATION TECHNOLOGIES INC - INSURANCE CERTIFICATE (6)Client#: 1084369 CONCRSTA ACORD,, CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 12/19/2018 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME: T Client Manager USI Colorado, LLC Construction PHONE g00 873-8500 30 aC, Nc Et): A/c Nc : 3-831-5295 P.O. Box 7050 ADDRESS: den.COntraCtOrS@usi.com Englewood, CO 80155 800 873-8500 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Peleus Insurance Company 34118 INSURED Concrete Stabilization Technologies,lnc INSURER B : National Union Fire Ins Pittsburgh, PA 19445 INsuRERc: PlnmacclAs:uran«Company 41190 8500 E. Warren Avenue INSURER D Westaeldinsurance Company 24112 Denver, CO 80231 — INSURER E : INSURER F : 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 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. LT R LTR TYPE OF INSURANCE ADDLISUBR NSR WVD POLICY NUMBER MMIDIDY/YEYYY MM/DDY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY FIVICLAIMS-MADE X OCCUR BI/PD Ded:$10,000 103GLOO2139002 01101/2019�01101112020 EACHOCCURRENCE $1 000,000 DAMAGE TO RENTED PREMISES Ea occurrence $50,000 $ 5,000 X; MED EXP (Any one person) PERSONAL & ADV INJURY _ $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRO - POLICY F7X ECT 1 LOC OTHER: GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP/OP AGG $2,000,000 $ D AUTOMOBILE X LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY X AUTOS ONLY TRA5119279 1/01/2019 01/01/202 COMBINED SINGLE LIMIT Ea accident 1,000,000 BODILY INJURY (Per person) $ X BODILY INJURY (Per accident) $ -- $ PROPERTY DAMAGE Per accident $ -- B X UMBRELLA LIAB EXCESS LIAR X OCCUR CLAIMS -MADE EBU066003226 1/01/2019 01/01/2020 EACH OCCURRENCE s2,000,000 AGGREGATE s2,000,000 DED RETENTION $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY vim N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A 4121092 1/01/2019 01/01/2020 X PER T OTH- ER E.L. EACH ACCIDENT $500000 E.L. DISEASE - EA EMPLOYEE $500000 E.L. DISEASE - POLICY LIMIT $5OO OOO DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The General Liability and Automobile Liability policies include an automatic Additional Insured endorsement that provides Additional Insured status to the Certificate Holder only when there is a written contract that requires such status, and only with regard to work performed on behalf of the named insured. %,r-M I IrK.A I a nvLUr-K GANGELLATION City of Fort Collins 215 N. Manson St. 2nd Floor P.O. 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. AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) 1 of 1 #S245229371M24508044 ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD DVPZP