HomeMy WebLinkAbout476316 BEDROCK LLC - INSURANCE CERTIFICATE�.�. ^ O®
A (�f'%� CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/Y)
o2/20/20192019
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 Kylie Carey, CISR, CIC
NAME:
Flood and Peterson
PHONE (970) 266-7148 FAX (970) 506-6845
AIC No Ext : A/C No :
E-MAIL KCarey@floodpeterson.com
ADDRESS:
PO Box 578
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURER A: Westfield Insurance Company
24112
Greeley CO 80632
INSURED
INSURER B : Plnnacol Assurance
41190
INSURER C : Travelers Property Casualty Company
36161
Bedrock, LLC,
INSURER D :
1501 Backhoe Road
INSURER E :
INSURER F :
Loveland CO 80537
COVERAGES CERTIFICATE NUMBER: FICrtx3/1/20-Bedrock 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 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.
INTR
R
TYPE OF INSURANCE
INSD
WVD
POLICY NUMBER
MM/DDY/WYY
EXP
/YYYY
MMIDDY
LIMITS
X
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
CLAIMS -MADE � OCCUR
DAMAGE TO RENTM7_
PREMISES Ea occurrence
$ 500,000
MED EXP (Any one person)
$ 5,000
PERSONAL&ADV INJURY
$ 1,000,000
A
TRA5246965
03/01/2019
03/01/2020
GEN'LAGGREGATE LIMIT APPLIESPER:
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS - COMP/OPAGG
$ 2,000,000
POLICY PRO CT LOC
$
OTHER:
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
Ea accident
$ 1,000,000
BODILY INJURY (Per person)
$
X ANYAUTO
BODILY INJURY (Per accident)
$
A
OWNED SCHEDULED
AUTOS ONLY AUTOS
HIRED NON -OWNED
X AUTOS ONLY X AUTOS ONLY
TRA5246965
03/01/2019
03/01/2020
PROPERTY DAMAGE
Per accident
$
Medical payments
$ 5,000
X
UMBRELLALIAB
X
OCCUR
EACH OCCURRENCE
$ 5,000,000
A
EXCESS LIAB
CLAIMS -MADE
TRA5246965
03/01/2019
03/01/2020
AGGREGATE
$ 5,000,000
DED I X1 RETENTION $ 0
$
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETOR/PARTNER/EXECUTIVE F—N]
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
NIA
4069771
03/01/2019
03/01/2020
u PER STATUTE EORH
E.L. EACH ACCIDENT
1,000,000
$
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
If yes, describe under
' DESCRIPTION OF OPERATIONS below
C
Leased/Rented Equipment
QT6604H594650TIL19
03/01/2019
03/01/2020
$70,000 Limit
$2,500 Deductible
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required)
Certificate holder is included as Additional Insured as required by written contract with respects to liability arising out of work performed by the named
insured.
CFRTIFICATE HOLDER CANCELLATION
City of Fort Collins
P.O. Box 580
215 N Mason St., 2nd Floor
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
U 1988-2015 ACORD CORPORATION. All ngnts reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD