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HomeMy WebLinkAboutNIXCAVATING INC - INSURANCE CERTIFICATE (5)AC EI DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 9/23/2015 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 endorsement(s). PRODUCER CONTACT Karole Peters NAME: Ewing -Leavitt Insurance Agency PNONE (970) 679-7355 A/C No: (866)237-2178 4025 St. Cloud Dr. ADDRESS: karole-peters@leavitt.com Suite 100 INSURERS AFFORDING COVERAGE NAIC # Loveland CO 80538 INSURERA:Cincinnati Insurance Cc 10677 INSURED INSURERB:Pinnacol Assurance 41190 Nixcavating, Inc. INSURER C : P. O. Box 2232 u� ono J Longmont CO 80501 I INSURER F: COVERAGES CERTIFICATE NLIMBER-15-16 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MMIDDM'YY MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EPP0124847 10/1/2015 10/1/2016 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE EXI OCCUR DAMAGE TO RETED PREMISES (Ea occurrence) ) $ 500,000 X MED EXP (Any one person) $ 10,000 Blkt Adddi tional Insured X Blkt Waiver of Subro PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY JECOT- LOC PRODUCTS - COMP/OPAGG $ 2,000,000 $ OTHER: A AUTOMOBILE LIABILITY EPP0124847 10/1/2015 10/1/2016 COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident)$ NON -OWNED X HIRED AUTOS X AUTOS $ X Blkt At X Blkt WOS A X UMBRELLA LIAB X OCCUR EPP0124847 10/1/2015 10/1/2016 EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 EXCESS LAB CLAIMS -MADE DIEDX RETENTION $ 0 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N 2113100 Blanket Waiver of 1/1/2015 1/1/2016 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) N/A Subrogation E.L. DISEASE - EA EMPLOYE9 $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below I I E.L. DISEASE - POLICY LIMIT 1 $ 1,000,000 A Inland Marine EPP0124847 10/1/2015 10/1/2016 Leased Or Rented Equipment $200,000 With $500 Deductible DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Fort Collins is additional insured on the general liability policy as regards work performed by the 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. AUTHORIZED REPRESENTATIVE Karole Peters/KAPETE�"�-*�-� ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (201401)