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HomeMy WebLinkAboutNATIONAL PAVEMENT PARTNERS LTD - INSURANCE CERTIFICATENATIO-3 ACORN CERTIFICATE OF LIABILITY INSURANCE D08130ATE /2019 ) 08I3012019 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 970-482-7747 CONTACT Karen E. Siwek NAME Brown & Brown Inc PHONE 970-482-7747 FAX 970-484-4165 4532 Boardwalk Dr, Suite 200 (AIC, No, E#: (AIC, No): Fort Collins, CO 80525 E- oRRE ; certl (sates bcolorado.com Karen E. Siwek, CPA INSURERS) AFFORDING COVERAGE NAIC # INSURER A: National American Insurance Co 23663 INSURED National Pavement Partners Ltd INSURER 8:Great American Insurance CO 16691 National Pavement Markings LLC American Milling Inc INSURERc: PO BOX 5485 INSURER D: _ Denver, CO 80217 INSURER E: I_ rn%1C0Anee CERTIFICATc ul MRFR• REVISION NUMBER* v 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 tTR TYPE OF INSURANCE AOOL 9U POLICY NUMBER POLICY EFF POLIrYM CY EXPDIYYYY LIMITS A X COMMERCIAL GENERAL UASIUr Y CLAIMS -MADE ❑X OCCUR y MP23620005 09/01/2019 09/01/2020 EACH OCCURRENCE $ 1,000,000 AMAGE TO RENTED DPREMISES fEa o=ma 100,000 III MED EXP (Any one arson 5,000 PERSONAL & ADV INJURY 111 1,000,000 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY LOG OTHER GENERAL AGGREGATE PRODUCTS - COMPIOP AGO $ 2,000,000 A AUTOMOBILE LIABILITY X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS Vy AUTODS ONLY AM ONLY MP23620006 09/01/2019 OW0112020 COMBINED SINGLE LIMIT (Es amident) 1,000,000 $ BODILY INJURY Per on BODILY INJURY Per accident PEF I ear acd AMAGE A UMBRELLA LL4B EXCESS LIAR X OCCUR I CLAIMS -MADE MB55550005 09/01/2019 09/01/2020 EACH OCCURRENCE $ 4,000,000 X II AGGREGATE $ 4,000'000 DIED X RETENTION $ 0 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN OFFICER/MEMBER in ER EXCLUDED? ECUTIVE ❑ NY (Mandatory in ER h yes describe under DESCRIPTION OF OPERATIONS below NIA PER UTE OTH- I $ $ E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE - p ICY LIMIT B 'Lease/Rent Equip TBD 09M1/2019 09/01/2020 Limit 100,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) City of Fort Collins is included as Additional Insured per policy forms and conditions. CITYF10 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Fort Collins 215 N. Mason St. AUTHORIZED REPRESENTATIVE Fort Collins, CO 80521 Karen E. Siwek, CPA ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD