Loading...
HomeMy WebLinkAbout103166 ZAK DIRT - INSURANCE CERTIFICATE (4)ACCORD® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 9/25/2015 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 Ewing -Leavitt Insurance Agency 4025 St. Cloud Dr. Suite 100 Loveland CO 80538 CONTACT Renee McReynolds NAME: y PHONN E (970)679-7344 FAX No:866.a25.6180 E-MAILss:renee-mcreynolds@leavitt.com ADDRE INSURERS AFFORDING COVERAGE NAIC # INSURERA:Cincinnati Insurance Co 10677 INSURED Zak Dirt, Inc. 14290 Hilltop Road Longmont CO 80504 INSURER B :Pinnacol Assurance 41190 INSURERC:National Union Fire Ins Co 19445 INSURER D : INSURER E : _ INSURER F: COVERAGES CERTIFICATE NUMBER: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 LTR TYPE OF INSURANCE ADDL UBR POLICY NUMBER MM/DDPLICYIYYYY YYY MM/DD/YE LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE Fx7 OCCUR DAMAGE To RETED PREMISES Ea occurrence $ 500,000 x MED EXP (Any one person) $ 10,000 Blkt Addl Insureds EPP0279653 10/1/2015 10/1/2016 x Blkt WOS PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS -COMP/OP AGG $ 2,000,000 POLICY [�] PRO LOC JECT $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ A X ANY AUTO ALL OSCHEDULED AUTOS AUTOS NON -OWNED X HIRED AUTOS X AUTOS EPP0279653 10/1/2015 10/1/2016 BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident)$ Limit $ 4,000,000 X Blkt WOS X Blkt Addl Insureds Excess Auto Liability incl C UMBRELLA LIAB X OCCUR 10/1/2015 10/1/2016 EACH OCCURRENCE $ 5,000,000 �DED AGGREGATE $ 5,000,000 EXCESS LIAB CLAIMS -MADE BE034204981 RETENTION$ $ Excess GL/EL WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N including Blanket Waiver of Subrogation x STATUTE ERH E.L. EACH ACCIDENT $ 500 000 B OFFICER/MEMBER EXCLUDED? inNH) (Mandatory in NIA 846620 10/1/2015 10/1/2016 E.L. DISEASE - EA EMPLOYE $ 500 000 E.L. DISEASE - POLICY LIMIT $ 500,000 If yes, describe under DESCRIPTION OF OPERATIONS below A Contractors' Equipment EPP0279653 10/1/2015 10/1/2016 $500,000 Limit/$1,000 ded Installation Fltr $50,000 Leased/Rented Equipment DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) re: N College Improvements Project - Conifer to Willox, Job #STE M455-106/7673 Certificate holder and Colorado Department of Transporation are named additional insured under both the general and auto liability policies. rFRTIFICATF HOLDER CANCELLATION City of Fort Collins Purchasing Div P 0 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 McReynolds/RESTEI�rn ACORD 25 (2014/01) INS025 (201401) ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD