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HomeMy WebLinkAboutDIAMOND EXCAVATING INC - INSURANCE CERTIFICATE (7)DIAMEXC-01 SARP .ACORo CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) `66.� 3/28/2019 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 Forsberg Engerman Company an affiliate of Mountain West Insurance 8, PHONE Financial Services, LLC A/C, Ni 3575 S Sherman Street E-MAIL Englewood, CO 80113 INSURED Diamond Excavating Inc 5940 W 59th Ave Arvada, CO 80003 Sarah Forsberg Tripp d,(303) 762-1717 103 Cincinnati Insurance COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 762-1733 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. ILT R �ADDLISUBR POLICY EFF POLICY EXP TYPE OF INSURANCE IN DAND POLICY NUMBER (MMIDD/YYYY) (MM/DDIYYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR j X ENP0172168 1/7/2019 1/7/2020 DAMAGE TO RENTED PREMISES Ea occurrence) 500,000 $ MED EXP (Any oneperson) $ 10,000 PERSONAL & ADV INJURY 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 2,000,000 POLICY F7X jE LOC PRODUCTS - COMP/OP AGG 2,000,000 OTHER: A AUTOMOBILE LIABILITY COMBINEDatSINGLE LIMIT $ 1,000,000 BODILY INJURY Perperson) $ X ANY AUTO ENP 0172168 1/7/2019 1/7/2020 BODILY INJURY Per accident $ OWNED SCHEDULED AUTOS ONLY AUTOS PeraccitlentDAMAGE $ X HIRED X NON -AWNED AUTOS ONLY AUTOS ONLY A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE 5,000,000 EXCESS LIAB CLAIMS -MADE ENP 0172168 1/7/2019 1/7/2020 AGGREGATE $ 5,000,000 DED RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY N ANY PROPRIETOR/PARTNER/EXECUTIVE -N OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N / A 2296640 4/1/2019 4/1/2020 X PER UT X OTH- ER 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 Equip 5X98205 1/7/2019 1/7/2020 Limit 300,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Right of Way Contractor License The City of Fort Collins is named as additional insured with respect to general liability per form GA472 09/17. a:4 1 City of Fort Collins PO Box 580 Ft Collins, CO 80522-0580 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) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD