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Home My WebLink About353928 CONCRETE STABILIZATION TECHNOLOGIES INC - INSURANCE CERTIFICATE (10)Clierft 1084369 CONCRSTA ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 9/01 /2015 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 policles may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAIL€A.CT - US[ Colorado, LLC P.O. Box 7050 PHONE FM Ext: 800 873$500 FM (Alac No: E-MAIL ADDRESS: den.contractors@usi.biz Englewood, CO 80155 INSURERM AFFORDING COVERAGE NAIC M INSURER A: United Specialty Insurance Comp 12537 INSURED INSURER B: Plnnacol Assurance Company 41190 Concrete Stabilization Technologies,lnc INSURERC: Cincinnati Insurance Company 10677 8500 E. Warren Avenue Denver, CO 80231 INSURER D : INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER: 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 CONTRACTOR 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 ADD g SUB POUCY NUMBER POLICY EFF M D POLICY EXP DD LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE O OCCUR X BI/PD Ded: $25,000 _ BV01573201 - .z7 ,:f' - ., -.. •- I , 01/01/2015 �. 01/01/2016 EACHOCCURRENCE$1,000,000 PREMISESOEaocwEr2nce S50000 MED EXP (Any one person) s N A PERSONAL& ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000. _ -GEN'LAGGREGATEUMITAPPUES PER:. - 'POLICY X PRO- : LOC PRODUCTS - COMP/OP AGG 52000000 _ $ C AUTOMOBILE IX UABLITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS$ HIRED AUTOS X AUTOS - EBA0173576 01/01/2015 01/01/201 - ----BODILY EOaBINEDSINGLELIMIT 1,000,000 INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY accident) DAMAGE A )( UMBRELLA UAB EXCESS LAB x occuR CLAIMS -MADE I BU01553178 01/01/2015 01/01/2016 EACH OCCURRENCE s2,000,000 AGGREGATE s2,000,000 LIED I I RETENTION$ $ B WORKERS COMPENSATION AND EMPLOYERS' UABIUTY ANY PROPRIETOR/PARTNEFUEXECUTIVF Y / N OFFICER/MEMBER EXCWDED? -. N (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A 4121092 01/01/2015 01/01/201 X WCSTATU- OTH- E.L. EACH ACCIDENT $500OOO E.L. DISEASE - EA EMPLOYEE $500 000 E.L. DISEASE -POLICY LIMIT s500,000 A Stop Gap Employer Liab. WY BV01573201 01/01/2015 01/01/2016 Ea Accident $1,000,000 Ea Employee $1,000,000 Aggregate $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) City of Fort Collins Financial Services Purchasing Division 215 N. Mason Street, 2nd Floor P.O. Sox 580 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 (2010105) r of 1 The ACORD asrsros852/M758g8995 ame and /090 —�i 1,