HomeMy WebLinkAboutDIAMOND EXCAVATING INC - INSURANCE CERTIFICATE (8)DIAMEXC-01
SARAH
DATE 3/191219/20200
.�►COR®� CERTIFICATE OF LIABILITY INSURANCE
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR WEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGEAFFORDED 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 teams 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.endorsement(s)..
PRODUCER
C AcT Sarah Forsberg Tripp - - - -
Mountain West Insurance - Englewood,
3575 S Sherman Street
Englewood, CO 80111
PHONE FAX .
. A/C,No,Ea: 303 590-9585 ac No:(303 762-1733
Mss, sarahf@mtnwst.com
INSURE S) AFFORDING COVERAGE
NAIC#
INSURER A: Cincinnati Insurance Company
10677
INSURED
_
INSURER B: Pinnacol.Assurance
41190
Diamond Excavating Inc
Colorado Forestry Management
5940 W.59th Ave
INSURERC: Employees Mutual Casualty Company
21415.
INSURER D: Westchester Surplus Lines Insurance Com an
10172
INSURER E :
Arvada, CO 80003
INSURER F :
Cr1VPRAr:PC r=0TIVI1'ATC WI IaaCCD• mcineinal urnaeen.
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
TYPE OF INSURANCE
ADOLSUBR
POLICY NUMBER
POLICY EFF.
POLICY EXP..
LIMRS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE OCCUR
X
_
ENP0172168
_
1r1/2020
1/7/2021
•
EACH OCCURRENCE
$ 1,000,000
DAMAGE TO RENTED
PREMISES Es occurrence)MED
$ 400,000
EXP (Any one n
$ 10,000
PERSONAL B ADV. INJURY
$ 1-1000,000
GEN'L
AGGREGATE LIMIT APPLIES PER:
POLICY ❑X ippa LOC
OTHER: _
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS-COMP/OP AGG
$ 2,000,000
$
A
AUTOMOBILE
LIABILITY
ANY AUTO
OWNEDSCHEDULED
AUgqT��O��S ONLY AUpTNOpSW E
ONLY X AUTOS ON Y
ENP0172168
1r7/2020
1/7/2021
COMBINED SINGLE LIMIT
(Ea accidentlIx
$ 1,000,000
BODILYINJURV Per rson
BODILY INJURY- Per accident
$AIUTO.S
PReOP�EandT1, AMAGE
$
A
X
UMBRELLA UAB
EXCESS UAB
X
OCCUR
CLAIMS -MADE
ENP 0172168
1 r7i2020
_
117/2021
_
EACHOCCURRENCE$
5,000,000
AGGREGATE
$ 5,000,600
DED I I RETENTION $
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
YIN
ANYPROPRIETORIPARTNERIEXECUTNE
XFICERIMEMg�� EXCLUDED? ❑N
(Mandatory In NH)
If es,desbemder
describe
OF OPERATIONS below
N / A
__
229664D
_ _
4l1/202D
__ _
I
4/1/2D21
_ _
X I PER. X 'OTH-
- FR
-
E.L. EACH ACCIDENT
$ 1,DDD,D00
E.L. DISEASE - EA EMPLOYE
$ 1,000,000
. _
E.L. DISEASE -POLICY LIMIT
11,000,000DE
C
D
Leased/Rented Equip
Pollution Liability
SX98205
G71497628002
1/7/2020
2/27/2020
177/2021
2/27/2021
Limit
Each0cc2,000,060/Agg
300,000
2,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks SUiedule, may be attached If more space Is required)
RE: Right of Way Contractor License
The City of Fort Collins is named as additional insured with respect to general liability per form GA472 09M8.
City of Fort Collins
PO Box 580
Ft Collins, CO 80522-0580
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
ACORD 25 (2016/03)
The ACORD name and logo are registered marks of ACORD
All riahts reserved