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HomeMy WebLinkAboutMETRO PAVERS INC - INSURANCE CERTIFICATE (7)DATE (MM/DD/YYYY) A� oRD® CERTIFICATE OF LIABILITY INSURANCE F911 0/2015 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 policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements . CONTACT PRODUCER NAME: TrueNorth Risk M mt CSG-CO TrueNorth PHONE 720-491-5411 FAX 303Ngh-776-5495 275 South Main Street, Ste 100 Extl*E-MAIL Longmont CO 80502 . certs@truenorthcompanies.com INSURERA:Westfield Insurance Company 24112 INSURED METRPAV-06 INSURERB:Pinnacol Assurance Company 41190 Metro Pavers, Inc INSURERC: PO Box 601 Henderson CO 80640 INSURER D: INSURER E : rr)VFRAr:FC CERTIFICATE MI IMRFR• 1874544383 RFVISIr1N MI IMRFR• 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 INSD WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYW LIMITS A X COMMERCIAL GENERAL LIABILITY CMM1987696 10/1/2015 10/1/2016 EACH OCCURRENCE $1,000,000 CLAIMS -MADE X� OCCUR A T RENT D PREMISES Ea occurrence $500,000 MED EXP (Any one person) $5,000 PERSONAL BADVINJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 IRI- POLICY JECT � LOC PRODUCTS - COMP/OP AGG $2,000,000 $ OTHER A AUTOMOBILE LIABILITY CMM1987696 10/1/2015 10/1/2016 (Ea accident) IN I I $1,000,000 BODILY INJURY (Per person) $ X ANY AUTO ALL OWNED SCHEDULED AUTOS BODILY INJURY (Per accident) $ NON -OWNED X HIRED AUTOS X AUTOS PROPERTY DAMAGE Per accident $ A X UMBRELLA LIAB X OCCUR CMM1987696 10/1/2015 10/1/2016 EACH OCCURRENCE $10,000,000 AGGREGATE $10,000,000 EXCESS LIAR CLAIMS -MADE DEC) X I RETENTION$0 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE 4177329 10/1/2015 10/1/2016 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? ❑ N / A E.L. DISEASE - EA EMPLOYEE -- -- $500,000 (Mandatory in NH) 11 yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT 1 $500,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) If Yes is indicated above for add'I insd forms Gen Liab #CG2010 10/01 (premises), #CG2037 10/01(completed operations), Auto Liab #CA7077 09/11 applies. If Yes is indicated above for waiver of subrogation forms Gen Liab #CG2037 10/01. Auto Liab CA0444 03110 and WC #WC000313 04/04 applies. Coverage is extended for work performed and required under written contract with the above named insured. CERTIFICATE HOLDER CANCELLATION City of Fort Collins PO 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. AUTHO IZED REPRESENTATIVE 44eov_-. © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD