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HomeMy WebLinkAboutROCKY MOUNTAIN STONE & CONCRETE FLATWORK LLC - INSURANCE CERTIFICATEACilt CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDM'YY) 7/23/2019 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 CONTACT Cassandra Talbot _NAME: FAX HONE Ext: (970) 356-8030 AIC No: (970)356-8032 Professional Risk LLC 8213 W.20th St EMAIL ADDRESS: cassie.talbot@proriskllc.com INSURERS AFFORDING COVERAGE NAIC # INSURERA: Liberty Mutual Insurance Cc Greeley CO 80634 INSURED INSURER B: Pinnacol Assurance 41190 INSURER C: Rocky Mountain Stone S Concrete Flatwork, LLC INSURER D: 1804 SW 10th INSURER E : INSURER F. Loveland CO 80537 COVERAGES CERTIFICATE NUMBER:19-20 All 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 rypE OF INSURANCE AD L UBR V POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MMIDD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 300,000 MED EXP (Any one person) $ 15,000 X an658901103 7/26/2019 7/26/2020 PERSONAL $ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE S 2,000,000 %t POLICY 1PRO- ECT OLOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident S BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY ntDAMAGE Per accide $ NON -OWNED HIRED AUTOS AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE S EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN X PER OTH- STATUTE ER ANY EEIEJ(ECUTIVE EL EACH ACCIDENT $ 500,000 OFFIB Mandatory In NH EXCLUDED? CERIMEMBER EXCLUDED? O (Mandatory ) NIA 4166544 8/1/2019 8/1/2020 EL. DISEASE - EA EMPLOYEE $ 500,000 If yes describe under DESCRIPTION OF OPERATIONS ou-1. E L DISEASE POLICY LIMIT I $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The City of Fort Collins is listed as additional insured as pertains to the General Lxabiity policy, per written contract. CERTIFICATE HOLDER CANCELLATION 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 REPRESENTATIVE tonne Perez/DP © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (201401)