HomeMy WebLinkAboutGOLD STAR CONCRETE INC - INSURANCE CERTIFICATE (4)A�REP CERTIFICATE OF LIABILITY INSURANCE
DATE a2o srn
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 poticy(les) 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 conter.rl hts to the certificate. holder .Irtileu:of.su ch.endorsement s . .
PRODUCER.
Commercial Risk Solutions
6600 E Hampden Ave Ste 200
Denver CO 80224
CONTACT
NAME; ScottAnderson,.CIC
PHONe 303-96-7833 -. ._ ac No: 3D3Z57-7719 _.
9
-
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ADDRESS: sanderson crsdenver.com
INSURERS AFFORDING COVERAGE
NAIC C
INSURER A: Employers Mutual Casualty Co.
21415
INSURED GOLST-2
Gold Star Concrete, Inc.
119 Muriel Dr.
INSURERS.: Plnnacol Asswance
41,190
INsuRERc:
INSURER o :
Northglenn CO 80233
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.
IN
LTR
TYPE OF INSURANCE
D
p
A
W
POLICYNUMBER
aouccr
MMODIY`)
POLIOy EXP
MUDDlYY
LIMITS
A
X
COMMERCIAL GENERALLIAmury
SX86815
5/612019
516/2020.
FACHOCCURRENCE
$1`,000,000
7
CLAIMS -MADE I OCCUR
DAMAGE TO RENTED
PREMISES (Ea occurrent '.
$500,000
MED. EXP. .(Any one erson)
$.10.000
PERSONAL &ADYINJURY
$1,000.000
GEN'L
AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 2,000,000
POLICYO jEC LOC
PRODUCTS -COMPIOPAGG
$2.000.000
.. . I
$ . . .
OTHER:
..
A
AUTOMOBILELL461LIT'I
-
SX86815
5162019
5162020
COMBINED SINGLE LIMIT
Ea aeodem
$1.000.000
X
BODILY INJURY (Per person)
$
ANY AUTO
OWNED SCHEDULED
AUTO$ ONLY AUTOS
BODILY INJURY(Peraccidenl),
$
X'
--
PROPERTY DAMAGE
Per a 'dem
$
HIRED X. NON -OWNED
AUTOS ONLY AUTOS ONLY
A
X
UTABRELLAd4B
X
OCCUR
5X86615
SWO19
5IM020
EACHOCCURRENCE
s4,000.000
AGGREGATE
$4,000,000
EXCESS LIAR
CLAIMS -MADE
DEC) RETENTION$
$. .. _... _.
_.
B
WORKERS COMPENSATION
AND EMPLAYERS'LIABILITY YIN
OFFICERIMEMSEREXCLUDED4
NIA
4187477
11/12019
IIll 2020
X I SPER
TATUTE . £Rif
E.L. EACH ACCIDENT
$500,000
E.L. DISEASE - EA EMPLOYEE
§ 560.600
(Mandatory In NM
rr 9es;'oaserme. unoor
DESCRIPTION OF OPERATIONS below
_
EL. DISEASE - POLICY LIMIT
E 500,000
A
Leased &Rented
EquipmentSoo
5XB6615
5162019
5/62020
Limit
25,000
DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (ACORD 101,Additional Remarks Schedule,may be alteched if more space Is raquired)
Certificate holder is included as additional insured on the General Liability With respect to ongoing and completed operations of the named insured for the
certificate holder as required byvititten 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.
01980.2015 ACORD CORPORATION. All rights.reserved.
ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
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