HomeMy WebLinkAboutGOLD STAR CONCRETE INC - INSURANCE CERTIFICATE (3)lb. D® CERTIFICATE OF LIABILITY INSURANCE
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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 INSURERIS), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATEHOLDER.
IMPORTANT: If the certificate-. holder Is an ADDITIONAL INSURED, the pollcy(les) must have ADDITIONAL INSURED provlslons'or be endorsed_.
If SUBROGATION IS WAIVED, subject to the teens and conditionsof 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 endomemenf a . .
PRODUCER
Commercial Risk.Sol Utions
6600'E Hampden Ave Ste 200
Denver CO 80224
NAME:, Scott Anderson CIC
-PHONE AX
303-996 7833 _. ac No: 303-757-7719
ED ass: s6nderson@crsdenver.com
INSU S AFFORDING COVERAGE.
NAIL p
INSURER A.: Employers Mutual Casualty Co.
21415
INSURED GOLST-2
Gold Star Concrete, Inc.
119 Muriel Dr.
INSURER B : Plnnacol Assurance
41 190
INSURER C
INSURER D:
Northgienn CO 80233
INSURER E
INSURER F :
COVERAGES CERTIFICATE NUMBER* 82650339 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.
INggR
LTR
rypE OF INSURANCE
OL
R
POLICYNUMBER
POLICY EFF
MMIDDIYY
POLIppY EXP -
AWD/YY
LIMITS:
A
X COMMERCIAL GENERAL LIABILITY
5XB6615
5162019
5WO20
EACH OCCURRENCE
$.1:000,000
CLAIMS -MADE FRI OCCUR
DAMAGE TO FIFN
PREMISES Me ocwrrence"
$500,000
MED EXP (Any one neon)
$.10,000
,PERSONAL &"ADVINJURY
$1,00,000
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$2,000,000
POLICY [K jE"coT El LOC
PRODUCTS -COMPIOPAGO
$2,OD0,000
$'
OTHER:
A.
AUTOMOBILELWBILITY
8X86615
"
516/,2019
51612020.
COMBINED SINGLE "LIMIT
Ea aoddan)
$1.000.000
X
BODILY INJURY (Per person)
_
S
ANY AUTO
OWNED SCHEDULED
-AUTOS ONLY AUTOS
-
BODILY INJURY (Per accident)
$
X
PROPERTY DAMAGE
Per accIdentI
$:
HIRED X NON -OWNED
AUTOS ONLY - - AUTOS ONLY
$
A
X
UMBRELLALIAB
'X
OCCUR
SX86615
51612011
5/612020
EACH000URRENCE... ..sA.000.000
AGGREGATE.
$4-,,000,000
EXCESS LIAS
CLAIMS -MADE
F=
I.RETENTION _. .. _ .
_ _
_ .. ._ _ .____. _
.S.... _.
....
_
_ _I
.__.. - I ....
_.. ... __.
._ _. __. ..
B
WORKERSCOMPENSATION -
AND EMPLOYERS' LIABILITY YIN
ECUTIVE
(Mandatory In NH) a
NIA
4187477
1/11/2018
11/12020
X E
STATUTE I
O
ER
E.L. EACH ACCIDENT.
$500,000OFFICERIMEMSEREXCLUDED?
. E.L. DISEASE- EA EMPLOYEE
-
$ 500,000
"Ias, descnbe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$ 500,000:
A.
Leased & Rerded
EgWpment
5X86615
- 5162019
5162D20
I
Uml
Dad
25.000
500
DESCRIPTION OF OPERATIONS t LOCATIONS I VEHICLES (ACORD 101, AddiOonel Remarks Schedule, maybe allwhad R more space Is required)
Certificate holder is included.as additional insured on the General Liability with respect to ongoing and completed operations of the named insured for
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 ABOVE' DESCRIBED POLICIES BE CANCELLED BEFORE;,
THE EXPIRATION DATE THEREOF, NOTICE WILL BE 'DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
ACORD 25 (2016/03)
The ACORD name and logo are registered marks of ACORD
All rights reserved.
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