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HomeMy WebLinkAboutADVANCED UNDERGROUND INC - INSURANCE CERTIFICATE (4)AC� � rYYYY) CERTIFICATE OF LIABILITY INSURANCE DATE 4(MM/DD(MM/DD9 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 NAME:. Commercial Risk Solutions Shang Tamayo — __ 6600 E. Hampden Ave., Ste. 200 PHONE 303-996-7842 ' F'-fANo ; 303-757-7719 Denver CO 80224 E-MAIL stamavo0,crsdenver.com INSURED Advanced Underground, Inc. Frontier Underground, LLC P.O. Box 1063 Brighton CO 80601 ADVA-11 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Plnnacol Assurance 41190 INSURER E : Co. COVERAGES rFRTIFIr:ATF NI IMRFR, 130d374171 RFVICI!'SN NI IMRGR• 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. P&i_dVEFF POLICYEXP LTR I TYPE OF INSURANCE INSID WVD POLICY NUMBER MM / MID /YYYY LIMITS B X I COMMERCIAL GENERAL LIABILITY � - - — CLAIMS MADE I I OCCUR _ — — ^ — Y 5X89221 7/1/2018 7/1/2019 EACH OCCURRENCE pR�M)�Gr �AAr>� one _r on) _ $1,000,D00 $ 500,000_— $ 5,000 $1,000,000 PERSONAL & ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER: POLICY %( PRO- LOC $ 2,000,D00 GENERAL AGGREGATE PRODUCTS - COMP/OP AGG $ 2,000 ^000 _._. OTHER: $ B AUTOMOBILE LIABILITY SX89221 7/1/2018 7/1/2019 COMBINED SINGLE LIMIT $1,000,000 BODILY INJURY (Per person) $ X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ X HIRED x NON -OWNED AUTOS ONLY AUTOS ONLY _ PROPERTY DAMAGE �r.$SEl4.gnll $ $ B X UMBRELLA LIAR X OCCUR I 5XB9221 7/1/2018 7/1/2019 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5.000,000 EXCESS LIAB CLAIMS -MADE DED X ! RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETOR/PARTNEREXECUTIVE Y OFFICER/MEMBER EXCLUDED? �(Mandato InNN ry ) N / A 4076345 1/1/2019 1/1/2020 X PER OTH- —. ATi/TE (I FER _ E.L. EACH ACCIDENT — ----. E.L. DISEASE - EA EMPLOYEE --"— "—�"—"—"'—"' $1,000,000 __....._._.....__ --.-----.----.-. $1,000,000 10 yes. describe under DESCRIPTION OF OPERATIONS below - $ 1,000,000 E.L. DISEASE - POLICY LIMIT B Leased & Rented Equipment 5XB9221 7/1/2018 71l/2019 Limit 100,000 Deductible 1,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached It more space is required) City of Fort Collins is included as additional insured on the General Liability with respect to ongoing operations of the named insured for the certificate holder as required by written contract. All policy terms, conditions and exclusions apply. City of Fort Collins PO Box 580 Fort Collins CO 80522 CANCELLATION 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 REPRESENTATI� © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 2 of 2 16969