HomeMy WebLinkAboutFRONT RANGE CONCRETE LLC - INSURANCE CERTIFICATE (3)ACORDM
CERTIFICATE OF LIABILITY INSURANCE
DATE N+4/DDIYV"
OW14/2019
I
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 policyiies) 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 comes rights to the certificate holder In lieu of such endorsements .
PRODUCER
FEDERATED MUTUAL INSURANCE COMPANY
HOME OFFICE: P.O. BOX 328
NAME: CT CLIENT CONTACT CENTER
(Al., . EXI : 888-333-4949 F� No:507-446-4664
ADDRESS: CLIENTCONTACTCENTER FEDINS.COM
OWATONNA, MN 55060
INSURER(S) AFFORDING COVERAGE
NAIL #
INSURER A: FEDERATED MUTUAL INSURANCE COMPANY
13935
INSURED 173.737-8
INSURER B:
FRONT RANGE CONCRETE LLC
M48 COUNTY ROAD 56
INSURER C:
INSURER D:
JOHNSTOWN, CO 80534-8236
INSURER E:
INSURER F:
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'� {ypE OF INSURANCE
LTR'
DL
INSR
SUBR
WLTJ
POLICY NUMBER
POLICY EFF
MMMDIYYYYI
POLICY EXP
(MMIDDIYYYYI
LIMITS
X
I COMMERCIAL GENERAL UABILITY
EACH OCCURRENCE
$110001000
CLAIMS -MADE ❑X OCCUR
DAMAGE TO RENTEDES Me n
§100,000
NED EXP (My one person)
$10.000
A
Y
N
9817040
10/01/2019
10/01/2020
PERSONAL& ADV INJURY
$1,000,000
O
X
N'L AOOREG LIMIT APPLIES PER',
PRO-
POLICY JECT E LOD
GENERAL AGGREOATE
$2,000,000
PRODUCTS - COMPIOP AGO
$2.000,000
OTHER:
AUTOMOBILE LIABILITY
X ANY AUTO
q —r OWNED AUTOS ONLY SCHEDULED
—� AUTOS
Y
N
9817040
70/01/2019
10/01/2020
COMBINED SINGLE OMIT
ee Idn
$1 OOO OOO
BODILY INJURY IPe, Fenian)
w
BODILY INJURY Ift, .,nil
NON -OWNED
LEI HIRED AUTOS ONLY ALTOS ONLY
PF.ROPEORITY DAMAGE
X
UMBRELLA LIAR
X
OCCUR
EACH OCCURRENCE
$5,DOO,ODO
A
EXCESS LIAR
CLAIMS -MADE
N
N
9817043
10/01/2019
10/01/2020
AGGREGATE
$5,000.000
DED RETENTION
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y y N
ANY PROPRIETORIPARTNERnEXECUTIVE
OTN-
X PER STATUTE ER
E.L. EACH ACCIDENT
$1,000,000
A
OMCERIMEMBER EXCLUDED
NIA
N
9272976
10/01/2019
10/01/2020
E.L. DISEASE - EA EMPLOYEE
$1 000 000
(e.nawwy in, NHL
If yes, desnNe unw{
DESCRIPTION OF OPERATIONS eelvr
El DISEASE - POLICY LIMIT
E1
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Md,ftft RemsHo SGMdvle, meY he eVeeh.d II more sp.o is neeuwod)
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.
173-737-8
CITY OF FORT COLLINS
PO BOX 580
FORT COLONS, CO 80522-0580
31 0
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
i
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