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HomeMy WebLinkAbout353928 CONCRETE STABILIZATION TECHNOLOGIES INC - INSURANCE CERTIFICATE (7)Client#: 1084369 CONCRSTA ACORDT. 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 CONTACT NAME: Manager USI Colorado, LLC Construction aC, 800 873-8500 vc No; 303-831-5295 _ P.O. Box 7050 n oRle Englewood, CO 80155 ss: den.contractors@usi.com INSURER(S) AFFORDING COVERAGE NAIC 0 BOO — -- -8500 — _ _ _ _ INSURER A : Palau. Insurance Company 34118 INSURED INSURER B : National union Fir. Ins Pittsburgh, PA 19445 Concrete Stabilization Technologies, Inc PlnnacolAs�uranc�Company 41190 8500 E. Warren Avenue INSURER C Westfield Insurance Company 24112 Denver, CO 80231 INSURER D INSURER E COVERAGES CFRTIFICOTF NIIMRFR• Dean mnat .0 uaDCD. 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. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MM/DD POLICY EXP MM/DD LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR BI/PD Ded:$10,000 103GLOO2139002 01/01/2019 01 /0112020 EACHOCCURRENCE$1 OOOOOO PREMISES Ea occurrence $50,000 X GEN'L MED EXP (Any one person) $5,000 PERSONAL & ADV INJURY $1,000,000 AGGREGATE LIMIT APPLIES PER: POLICY'L�J JECOT LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $2,000,000 _ $ D AUTOMOBILE X X LIABILITY ANY AUTO OWNED r SCHEDULED AUTOS ONLY �_ AUTOS AUTHIROS ONLY X NON -OWNED AUTOS ONLY TRA5119279 1/01/2019 01/01/202 MINED EaaccdentSINGLELIMIT) 1,000,000 BODILY INJURY (Per person) _ $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident -- $ _ B X UMBRELLA EXCESS LIAB X OCCUR CLAIMS -MADE EBU066003226 1/01/2019 01/01/202 EACH OCCURRENCE $2000000 AGGREGATE s2,000,000 DED RETENTION $ _ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? [7N (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A 4121092 1/01/2019 01/01/202 X PER OTH- T T E.L. EACH ACCIDENT $500000 E.L. DISEASE - EA EMPLOYEE $500 000 E.L. DISEASE - POLICY LIMIT $500,000 TT DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) As required by written contract or written agreement, the following provisions apply subject to the policy terms, conditions, limitations and exclusions: the Certificate Holder is included as Additional Insured for work, acts or omissions under the General Liability and Automobile Liability but only with respect to liability arising out of the Named Insured's work performed on behalf of the certificate holder. City of Fort Collins PO Box 580 Ft Collins, CO 80522-0000 uet. 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 #S24522936/M24508044 ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD DVPZP