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HomeMy WebLinkAboutROBERTS EXCAVATION CORPORATION - INSURANCE CERTIFICATE (16)ACORD® CERTIFICATE OF LIABILITY INSURANCE 1 DATE (MMIDDIYYYY) `�" 3/31/2020 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 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 endorsement(s). PRODUCER CONTACT NAME: Olson 8r, Olson Ltd PHONE' FAX 5655 S Yosemite Street #200 ; 303-867-2655 Arc No): 303-867-2074 ADDDRRES& certificates olsonandolson.com Greenwood Village CO 86111 INSURER(S) AFFORDING COVERAGE NAIC l/ INSURER A: Plnnacol. Assurance 41190 INSURED ROBER-2 INSURER B : Roberts Excavation Corporation Roberts Excavating INSURER C : INSURER D : 1801 1 st Street INSURERE: Berthoud CO 80513 :INSURER F.:.. COVERAGES CERTIFICATE NUMBER: 306165090 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. INSR LTR TYPE OF INSURANCE AD L UEI _. POLICY NUMBER-_ POUCYEFF MMID POLICY. EXP MM/DD LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR EACH OCCURRENCE $ DAMAGE TO PREMISES EaENTED o rmnce $ MED:EXP (Any one person) $ PERSONAL B ADV INJURY $ GENT AGGREGATE LIMIT APPLIES PER: POLICY PRO JECT LOC _.. OTHER:.. GENERAL AGGREGATE S PRODUCTS - COMP/OP AGG S $ AUTOMOBILE LWSILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIREDAUTOS AUTOS ' - - " - COMBINED Ea accident) - S BODILY INJURY (Per person) $ BODILYINJURY (Per accident) $ PROPERTY DAMAGE Per accident) $ $ UMBRELLA LIAR EXCESS LIAS OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETORIPARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? F­N] (Mandatory in NH) _ I/ yes, describe under DESCRIPTION OF. OPERATIONS below NIA - --- - _ 3241433 .. 4/1/2020 _ 4/1f2021 PER OTH- STATUTE ER E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,0D0,000 E.L. DISEASE - POLICY LIMIT $1,000 000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if mans space Is required) See Attached... CERTIFICATE HOLDER CANCELLATION City of Fort Collins 215 N Mason St Fort Collins CO 80521 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 (2014101) ©1988-2014 ACORD The ACORD name and logo are registered marks of ACORD All rights AGENCY CUSTOMER ID: ROBER-2 LOC #: ADDITIONAL REMARKS SCHEDULE Page t of t AGENCY NAMED INSURED Olson & Olson Ltd Roberts Excavation Corporation Roberts Excavating POLICY NUMBER 1801 1 st-Street Berthoud CO 80513 CARRIER NAIL CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE WORKERS COMPENSATION WC000313 Form Attached Includes: Blanket Waiver of Subrogation applies when required by written contract. IMPORTANT: The policy forms referenced will be sent via email only. To obtain copies, please send your request with the email address to o2@olsonandolson.com Contractor's License. ACORD101 (2008101) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD