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HomeMy WebLinkAbout476108 INTERSTATES CONSTRUCTION SERVICES INC - INSURANCE CERTIFICATE (5)ACC)R"• CERTIFICATE OF LIABILITY INSURANCE 16*.� 9/1/2020 1 F DATE(MMIDDNYYY) 8/15/2019 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 endorsement(s). PRODUCER Lockton Companies 444 W. 47th Street, Suite 900 Kansas City MO 64112-1906 (816) 960-9000 CONTACT NAME: PHONE FAX A/c, No, E t : ac, No E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURER A : The Travelers Indemnity Company 25658 INSURED INTERSTATES CONSTRUCTION SERVICES INC. 1450806 PO BOX 260 SIOUX CENTER IA 51250-0260 INSURER B : Travelers Indemnity Company of America 25666 Tmvelers Property Casualt Co of America INSURER C : P 25674 INSURER D : [lie Travelers Indemnity Company of Connecticut 25682 INSURER E: INSURER F Cf1VFRArFS * rFRTIFICOTF NIIMRFP- 1 SSSRd51 RFVI91r1N NI IMRFR• XXXXXXX 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 INSD SUBR WVD POLICY NUMBER POLICY EFF MM/DDIYYYY POLICY EXP MIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY Y N VTK-CO-7164B73-7-IND-19 9/1/2019 9/1/2020 EACH OCCURRENCE 1,000 000 CLAIMS -MADE OCCUR DAMAGE TO RENTED PREMISES Ea occurrence SOOOOO MED EXP (Any oneperson) 10,000 PERSONAL B ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY JE � LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000 000 $ OTHER: g AUTOMOBILE LIABILITY Y N VTHCAP7164B749TIA19 9/1/2019 9/1/2020 COMBINED SINGLE LIMIT Ea accident $ 1 OOO 000 }{ BODILY INJURY (Per person) $ YYYYYcx ANY AUTO AUTOS ONLY AUTOSULED 1AUTOS BODILY INJURY (Per accident $ XXXXYIXX HIRED NON -OWNED ONLY AUTOS ONLY PROPERTY DAMAGE Per accident $XXXXXXX $XXXXXXX C X UMBRELLA LIAB X OCCUR N N ZUP-21PI5736-19-NF 9/1/2019 9/1/2020 CCURRENCE $ 10,000,000 GATE $ 10,000,000 EXCESS LIAB CLAIMS -MAD DED X RETENTION $10,000 $ XXXXXXX D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY y I N OFFICER ME BER EXCLUDED? ANY ECUTIVE � (Myandatory In NH) rted under DESCRIPTION OF OPERATIONS below N / A N UB-3N434633-19-25-K 9/1/2019 9/l/2020 ATUTE GER RELDISEASE ACCIDENT $ 1,000,000 -EA EMPLOYEE 1,000,000 E L. DISEASE -POLICY LIMIT Is 1,000,000 C LEASED/RENTED EQUIPMENT N N QT-630-2L074879-TIL-19 9/1/2019 9/1/2020 $500,000 PER OCCURRENCE 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, CO, ITS OFFICERS, AGENTS, AND EMPLOYEES ARE INCLUDED AS ADDITIONAL INSUREDS ON THE GENERAL AND AUTO LIABILITY WHEN REQUIRED BY WRITTEN CONTRACT. GCK I It -ILA I L HULUtK L;ANCtLLA I IUN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 15558451 AUTHORIZED REPRESENTATIVE CITY OF FORT COLLINS ATTN: PURCHASING PO BOX 580 FORT COLLINS CO 80521 *-Ova Aca 4j ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved The ACORD name and logo are registered marks of ACORD