HomeMy WebLinkAboutFRONT RANGE CONCRETE LLC - INSURANCE CERTIFICATE (2)A16. ` CERTIFICATE OF LIABILITY INSURANCE
DATE 06/11/D/VYVY)
06/11/2019
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 endorsements .
PRODUCER
FEDERATED MUTUAL INSURANCE COMPANY
HOME OFFICE: P.O. BOX 328
CONTACT
NAME: CLIENT CONTACT CENTER
A CNNo Ext : 888-333-4949 a/c No): 507-446-4664
E-MAIL
ADDRESS: CLIENTCONTACTCENTER FEDINS.COM
OWATONNA, MN 55060
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURER A: FEDERATED MUTUAL INSURANCE COMPANY
13935
INSURED 173-737-8
INSURER B:
FRONT RANGE CONCRETE LLC
INSURER C:
6648 COUNTY ROAD 56
INSURER D:
JOHNSTOWN, CO 80534-8236
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 31 REVISION NUMBER: 2
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
TYPE OF INSURANCE
ADDL
INSR
SUER
WVD
POLICY NUMBER
POLICY EFF
MMIDD/YYYY
POLICY EXP
MMIDDIYYYY
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE ❑X OCCUR
Y
N
9817040
10/01/2018
10/01/2019
EACH OCCURRENCE
$1,000,000
DAMAGE ( RENTED
PREMISES Ea occurrence
$100 000
GEN'L
MED EXP (Any one person)
$10 000
PERSONAL & ADV INJURY
$1,000,000
AGGREGATE LIMIT APPLIES PER:
POLICY ❑ PEST ❑ LOC
OTHER:
GENERAL AGGREGATE
$2 000 000
PRODUCTS - COMPIOP AGG
$2,000,000
A
AUTOMOBILE
X
LIABILITY
ANY AUTO
OWNED AUTOS ONLY SCHEDULED
AUTOS
HIRED AUTOS ONLY NON -OWNED
AUTOS ONLY
Y
N
9817040
10/01/2018
10/01/2019
COMBINED SINGLE LIMIT
Ea accident
$1,000,000
BODILY INJURY (Per person)
BODILY INJURY (Per accident)
PROPERTY DAMAGE
Per accident
A
X
UMBRELLA LIAB
EXCESS LIAB
X
OCCUR
CLAIMS -MADE
N
N
9817043
10/01/2018
10/01/2019
EACH OCCURRENCE
$5,000,000
AGGREGATE
$5,000,000
DED RETENTION
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY �. / N
ANY PROPRIETORIPARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
It yes, describe under
DESCRIPTION OF OPERATIONS below
NIA
N
9272976
10/01/2018
10/01/2019
X
PER STATUTE
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
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
CITY OF FORT COLLINS IS AN ADDITIONAL INSURED SUBJECT TO THE CONDITIONS OF THE ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU ENDORSEMENT FOR GENERAL LIABILITY.
CERTIFICATE HOLDER CANCELLATION
173-737-8
CITY OF FORT COLLINS
PO BOX 580
FORT COLLINS, CO 80522-0580
31 2
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
O 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD