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HomeMy WebLinkAboutROBERTS EXCAVATION CORPORATION - INSURANCE CERTIFICATE (13)AC"R" CERTIFICATE OF LIABILITY INSURANCE fl%� 1 DATE (MMIDD/YYYY) 3/29/2019 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 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 Olson & Olson Ltd 5655 S Yosemite Street #200(,VC,No Greenwood Village CO 80111 CONTACT NAME: PHONE FAX E:c : 303-867-2055 A/C No): 303-867-2074 ADDRESS: o2@olsonandolson.com INSURERS AFFORDING COVERAGE NAIC # INSURER A: PlnnacolAssurance 41190 INSURED ROBER-2 INSURER B: Westfield Insurance Company 24112 Roberts Excavation Corporation Roberts Excavating INSURER c :Columbia Casualty Co 31127 1801 1st Street INSURER D : INSURER E Berthoud CO 80513 INSURER F COVERAGES CERTIFICATE NUMBER: 1137512574 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. INSR LTR OF INSURANCE ADDLTYPE INSD SUER POLICY NUMBER EFF MM/DD/YYYY MM/ DPOLICY Y EXP /YYYY LIMITS B X COMMERCIAL GENERAL LIABILITY TRA9707469 4/1/2019 4/1/2020 EACH OCCURRENCE $1,000,000 CLAIMS -MADE a OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $500,000 MED EXP (Any one person) $10,D00 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY PRO- [X]LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: B AUTOMOBILE LIABILITY TRA9707469 4/1/2019 4/1/2020 COMBINED SINGLE LIMIT Ea accident $1,000,000 BODILY INJURY (Per person) $ X ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS PROPERTY DAMAGE Per accidentt $ LXX NON-OWNED HIRED AUTOS X AUTOS B X UMBRELLA LIAB X OCCUR TRA9707469 4/1/2019 4/1/2020 EACH OCCURRENCE $3,000,000 AGGREGATE $ 3,000,000 EXCESS LIAB CLAIMS -MADE DED X RETENTION $ n $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑N NIA 3241433 6/1/2018 6/1/2019 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 (Mandatory in NH) E.L. .DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT 1 $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below C Pollution Liability 6072208749 4/1/2019 4/1/2020 Per Claim $1,000,000 Aggregate $1,000,000 Retention $10,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be affached if more space is required) Certificate Holder and those listed below(if any) are Additional Insureds as respects General Liability and Umbrella Liability on a Primary and Non -Contributory basis, and Auto Liability only if required by written contract or agreement and coverage applies only as respects work performed by the Insured for the Additional Insureds. All coverage terms, conditions, and exclusions of the policy apply. The Worker's Compensation, General Liability, Auto Liability, and Umbrella Liability policies include a Waiver of Subrogation in favor of the Additional Insureds only if required by written contract or agreement. CERTIFICATE HOLDER 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. City of Fort Collins 215 N Mason St Fort Collins CO 80521 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD