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HomeMy WebLinkAbout353928 CONCRETE STABILIZATION TECHNOLOGIES INC - INSURANCE CERTIFICATE (8)Client#: 1084369 CONCRSTA ACORDTM CERTIFICATE OF LIABILITY INSURANCE D12/192018ATE YY) 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 USI Colorado, LLC Construction P.O. Box 7050 Englewood, CO 80155 800 873-8500 NAME: Client Manager PHONE g00 873-8500 FAX 303-831-5295 A/C No Ext : AIC, No E-MAIL ss: den.contractors@usi.com INSURERS) AFFORDING COVERAGE NAIC q INSURER A: Peleus Insurance Company 34118 INSURED Concrete Stabilization Technologies,lnc 8500 E. Warren Avenue Denver, CO 80231 INSURER B • National Union Fire Ins Pittsburgh, PA 19445 INSURERC: PlnnacolAeauranceCampany 41190 INSURER D : Westfield Insurance Company 24112 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. LTR TYPE OF INSURANCE ADDLSUBR NSR WVD POLICY NUMBER MM/DDY/YYYY MM/DDY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 4 OCCUR BI/PD Ded:$10,000 103GLOO2139002 1/01/2019 01101/2020 EACH OCCURRENCE $1,000,000 _ PREMISES Ea occurrence $50,000 X MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $1,000,000 LAGGREGATELIMITAPPLIESPER: POLICY X1 PROT F LOC r,OTHER: GENERAL AGGREGATE $2,000,000 PRODUCTS-COMP/OPAGG $2,000,000 $ D AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY X AUTOS ONLY �INED TRA5119279 1/01/2019 01/01/202 COEaMB cciddentens) SINGLE LIMIT a 1,000,000 X BODILY INJURY (Per person) -- $ X BODILY INJURY (Per accident) $ PROPER DAMAGE Per accident _ $ B X UMBRELLA LIAB EXCESS LIAB N OCCUR CLAIMS -MADE EBU066003226 1/01/2019 01/01/2020 EACH OCCURRENCE s2,000,000 AGGREGATE $2 00O 000 DED RETENTION $ $ C AND EMPLOYERS' LIABILITY WORKERS COMPENSATION ANY PROPRIETOR/PARTNER/EXECUTIVE YIN N OFFICER/MEMBER EXCLUDED? � (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A 4121092 1/01/2019 01/01/202 OTH- X PERTuTE E.L. EACH ACCIDENT $500000 E.L. DISEASE - EA EMPLOYEE $500000 I E.L. DISEASE -POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I 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 City of Fort Collins is included as Additional Insured for work, acts or omissions under the General Liability and Automobile Liability on a primary and non contributory basis and Additional Insured under 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 Financial Services; Purchasing Division 215 N. Mason Street, 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 #S24522938/M24508044 ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD DVPZP