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Home My WebLink AboutADVANCED UNDERGROUND INC - INSURANCE CERTIFICATE (5)AC� ® 76/24/2019 (MM'DD!YYYY) �._.- CERTIFICATE OF LIABILITY INSURANCE 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 NAME: Shana Tama�ro_ _ Commercial Risk Solutions PHONE 3Exfiv03-996-7842 FAX 303-757-7719 6600 E. Hampden Ave., Ste. 200 E-MAIL Denver CO 80224 ADDRESS: stamayo0crsdenver.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Pinnacol Assurance 41190 INSURED ADVA-11 Advanced Underground, Inc. INSURER B: Employers Mutual Casualty Co. �._ 21415 -- Frontier Underground, LLC INSl1RERC: P.O. BOX 1063 INSURER D_q Brighton CO 80601 g INSURER E_: COVFRAGFS CFRTIFICATF NIIMRFA-7ZA1aza7� RFVICIr11J IJtIMRr-D. 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 I TYPE OF INSURANCE-T��iS� IN POLICY BER NUMMM DD/YLICYYYY MMODFF %r LTR YY LIIMITS 9 X I COMMERCIAL GENERAL LIABILITY Y 5XB9221 7/1/2019 7/1/2020 EACH OCCURRENCE $1.000,000 j CLAIMS -MADE L XJ, OCCUR PR.FM3.E$ EaBL_4 krr $ 500 D00 MED EXP A one arson $ 5 000 PERSONAL 8 ADV INJURY $1,000,D00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY jECT L__J LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: B AUTOMOBILE LIABILITY 5XB9221 711/2019 7/1/2020 COMBINED SINGLE LIMIT 1€A_eSEi n $1 000 000 BODILY INJURY (Per person) $ X ANY AUTO OWNED SCHEDULED AUTOS ONLYPXAUTOS BODILY INJURY (Per accident) $ X HIRED NON -OWNED AUTOS ONLYAUTOS ONLY PROPERTY DAMAGE$ Per alccidentl $ B X UMBRELLALIAB X OCCUR 5XB9221 7/1/2019 7/1/2020 EACH OCCURRENCE $5,000,000 AGGREGATE $ 5,000,000 EXCESS LIAB CLAIMS -MADE DED ! X ! RETENTION $ in nnp $ u A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETOR/PARTNEFL'EXECUTIVE - R/ OFFICEMEMBEREXCLUDED? N / A 4070345 - 1/1/2019 1/1/2020 .�X yPTAT OR _ . $1,000,000 E.L. EACH ACCIDENT --- E.L. DISEASE;EA EMPLOYEE _ -- - (Mandatory In NH) it yesdescribe under $1,000,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1,000,000 B Leased & Rented Equipment 5X89221 7/1/2019 7/1/2020 Umlt 100,000 Deductible 1,000 DESCRIPTION OF OPERATIONS) LOCATIONS; VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) City of Fort Collins is included as additional insured on the General Liability with respect to ongoing operations of the named insured for the certificate holder as required by written contract. All policy terms, conditions and exclusions apply. a.cn i r rz nvI-Lamm t;A1VlaLLA 1 IUN City of Fort Collins PO Box 580 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 REPRESof, NT C.-�' 91988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 2 or 2 15256