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Home My WebLink About608057 GOLD STAR CONCRETE INC - INSURANCE CERTIFICATE (5)AC"R" CERTIFICATE OF LIABILITY INSURANCE DATE(MM,'DD/YVYY) Ilklw�_ 1 5/3/2019 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. It 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; Scott Anderson, CIC Commercial Risk Solutions PHONE -- FAX 6600 E Hampden Ave Ste 200 303-996 7833 AC,No:303-757-7719 Denver CO 80224 ADDRESS: snderson crsdenver.com -., INSURER(S) AFFORDING COVERAGE _ NAIC # INSURER A: Employers Mutual Casualty Co. 1 21415 INSURED Gold Star Concrete, Inc. 119 Muriel Dr. Northglenn CO 80233 GOLST-2 COVERAGES CERTIFICATE NLIMRER:41171475427 RFVIRIAN NIIMRFR- 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. EFF LTR TYPE OF INSURANCE POLICY NUMBER'. MM'LDD YYYY (MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY 5XB6615 5/6/2019 5/6/2020 EACH OCCURRENCE j $ 1 000 Q00 _ DAfuTAGE TO R�iT1'1=t5 — -� ---- CLAIMS -MADE X OCCUR pR MI $ 500 000 MED EXP (Any one person] $10 000 PERSONAL & ADV INJURY $1,000,D00 GEN'L AGGREGATE LIMIT APPLIES PER: $ 2,000,D00 GENERAL AGGREGATE X POLICY �E T _ LOC PRODUCTS • COMP/OP AGG $ 2,000,000 I $ ji OTHER: A AUTOMOBILE LIABILITY SXW615 5/6/2019 5)'6/2020 COMBINED SINGLE LIMIT $ 1,000,000 (Ea _accident_____ X ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED ' AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED XNON-OWNED $X AUTOS ONLY AUTOS ONLY SPer acgidgng„_. _ _ $ A }(j UMBRELLA LIAB X OCCUR 5X88815 5/6/2019 5/6/2020 EACH OCCURRENCE $ 4.000 000 EXCESS UAB CLA1M5•MADE AGGREGATE $4,000,OW DIED RETENTION $ $ B WORKERS COMPENSATION 4187477 11/1/2018 11/1/2019 1 X PER ; OTH- STATUTE„ ER AND EMPLOYERS' LIABILITY Y / N E.L.ACH ACCIDENT ANYPROPRIETOR/PARTNERIEXECUTIVE $ 500,000 R/ OFFICEMEMBEREXCLUDED? ❑ N/A --- -- ------- (Mandatory in NH) E.L. DISEASE _ EA EMPLOYEE $ 500,000 It yes. describe under -..._....___..__._._�..�.__-.. ._._...__.._-._.... DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500.000 A Leased 8 Rented 5X88815 5/6/2119 116,2020 Limit 25.000 Equipment Ded i 500 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate holder is included as additional insured on the General Liability with respect to ongoing and completed 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 Purchasing Department P.O. Box 580 Fort Collins CO 80522 CANCELLA 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 rm 4noo II(Yia ArYIRr% (`.r1RPr1R&TIr1N &11 rinhtc re--prvprl_ ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 3 of 4 2543