HomeMy WebLinkAboutGOLD STAR CONCRETE INC - INSURANCE CERTIFICATE (2)AcoRo� CERTIFICATE OF LIABILITY INSURANCE
DATEtMM470nYrY,
10/412019
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 conferrights hts to the certificate holder in lieu of such endorsement s .
PRODUCER
Commercial Risk Solutions
6600 E Hampden Ave Ste 200
Denver CO 80224ADDRESS:
UUMAUT NAME: Scott Anderson, CIC
PHONE 303-996-7833.._ _._.. _._. ac Ro:303,757-7719.... ...
Sanderson crsdenver.com
.INSURE AFFORDING COVERAGE
NAICI
.INSURER A: Employe Mutual Casualty Co.
2 141 5
INSURED GOLST-2
Gold Star Concrete, Inc.
119 Muriel Of.
INSURER B :. Pinnacol Assurance
41.190.
INsuRERc:
INSURERD:
Northglenn CO 80233
INSURER E: �.
INSURER F:
.
COVERAGES CERTIFICATE NUMBER: 517339282 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
CERTCATE MAY BE ISSUED OR MAY PERTAIN, THE .INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THEr TERMS,
EXCLUSION_ S AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTRIN
TYPE OF INSURANCE
AUVLSUSR
W
POLICYNUMSER.
POLICY EFF
MMIDDfYY
.POLICY EXP.
MMIDDNYY.
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY-
5X86615
5162019
5/612020:
,EACHOCCIIRRENCE
$1,000,000
CLAIMS -MADE � OCCUR
DAMAGE TO RENTED
PREMISES Me'occurr nca
$500,000
MED.EXP(Any oneperson)
10,000
PERSONAL .&ADV. INJURY
$1.000,000
-
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERALAGGREGATE
$2,000,000
POR.
LICY.aX JECT LOC
PRODUCTS -COMPIOP AGG
$2.000,000
..
$ ....
.OTHER:. .. .... . -
- ..
.. ..
- -. ..
A
AXU
TOMOBLE LIABILTY
I
5..X886I5 - -5
2019
5/6/202
CMBcaINdEeDn BINGLE LIMIT
S t-,000.000 . - "
BODILY INJURY (Per, person)
$
ANY AUTO
OWNED SCHEDULED
.AUTOS ONLY AUTOS
BODILY INJURY {Per accident)
$
X
���
PROPERTY DAMAGE
Por'accid M
$.OWNED
HIRED X NON-
AUTOS ONLY � AUTOS ONLY.
s
A
X
UMBRELLA LIAB X BUR
j—'
5X86615
516=19
516I2020
EACHOCCURRENCE
$4,000.000 "
AGGREGATE
$4,000,000
EXCESSIJAB CWMS-MADE
�DED RETENTIONS.
$
B
WORKERS COMPENSATION- ---
AND EMPLOYERS' LIABILITY YIN
ANYPROPRIETORIPARTNEWEXECUTIVE a
OFFICER(MEMBEREXCLUDED4
NIA.
4187477 -"
1.1/1Y2019
11/111020
X !PERTUTE ER
-
E.L. EACH ACCIDENT
$500,000
E-L. DISEASE - EA EMPLOYE
$ 500,000
(Mandatory.. in NH)
It yes. d[rscribeunder
DESCRIPTION OF OPERATIONS bebw
-
-
E.L. DISEASE •POLICY LIMIT
$ 500,000
A
Leased & Rented
Equipment
5X86615
-
5/62019
-
5162020
Umn
Dad
25000
506
DESCRIPTION OF OPERATIONS I LOCATIONS f VEHICLES (ACORD 101, Addttional Remarks Schedule, may be attached lif more space Isrequbed) -
Certificate holder is included as additional insured on the General Liability with respect to ongoing and completed operations of -the named insured forthe
certificate holder as required by written contract.
All policy terms, conditions and exclusions apply.
City of Fort Collins
Purchasing Department
P.O. Box 580
Fort Collins CO 80522
SHOULD ANY OF THE ASOVEMESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
01935-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016103) The ACORD name and Togo are registered marks of ACORD
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