HomeMy WebLinkAboutS2CR INC DBA FRONT RANGE EXCAVATION - INSURANCE CERTIFICATE (3)/ ®
AC40Rv CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
02/28l2019
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 Trish Preuit
NAME:
Flood and Peterson
NE (g70) 506-3271 FAX (970) 330-1867
P H OAIC No Ext : AIC No
E-MAIL TPreuit@Floodpeterson.com
ADDRESS:
PO Box 578
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURER A : Plnnacol Assurance
41190
Greeley CO 80632
INSURED
INSURER B :
INSURERC:
S2cr, Inc., DBA: Front Range Excavation
INSURER D :
4411 West County Road 52e
INSURER E :
INSURER F :
Laporte CO 80535
COVERAGES CERTIFICATE NUMBER: CL1922827909 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 CONTRACTOR 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.
TR
TYPE OF INSURANCE
INSD
WVD
POLICY NUMBER
MMIDD/YYYY
POLICY EXP
MM/DDIIYYYY
LIMITS
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$
DAMAGE TO RENT177-
CLAIMS-MADE DOCCUR
PREMISES Ea occurrence
$
MED EXP (Any one person)
$
PERSONAL BADVINJURY
$
GEN'LAGGREGATE LIMITAPPLIES PER:
GENERAL AGGREGATE
$
POLICY ❑ PRO JECT ❑ LOC
PRODUCTS -COMPIOPAGG
$
$
OTHER
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
Ea accident
$
BODILY INJURY (Per person)
$
ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
Per accident
$
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
$
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$
AGGREGATE
$
EXCESS LIAB
CLAIMS -MADE
DED RETENTION $
$
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH)
NIA
1370000
04/01/2019
04/0112020
/� STER ATUTE �RH
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
1,000,000
$
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
l:tKI IFIL:AI t
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS.
PO Box 580
AUTHORIZED REPRESENTATIVE // .,L/
Fort Collins CO 80522 71�� ;%Zo
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