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HomeMy WebLinkAbout353928 CONCRETE STABILIZATION TECHNOLOGIES INC - INSURANCE CERTIFICATE (9)Client#: 1084369 CONCRSTA ACOR& CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDNYYY) 12I30/2015 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 USI Colorado, LLC C/L P.O. Box 7050 Englewood, CO 8O15S 800 873-8500 CONTACT NAME: Client Manager -8500 No303831-5295acNE=: 800 873 aC E-MAILADDREss, den.COntraClOrS@USI.bl2 INSURERS) AFFORDING COVERAGE NAIC# INSURER A: Knight Specialty Insurance Co 115366 INSURED Concrete Stabilization Technologies,lnc 8500 E. Warren Avenue INSURER B: Plnnacol Assurance Company 141190 Cincinnati Insurance Company INSURER C: P Y 10677 Denver, CO 80231 INSURER D : INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMRFR- 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 TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR BI/PD Ded:25000 - KSVENA160035507 o 1/01/2016 _ 01/01/2017 EACH OCCURRENCE $1 000000 AMA 70 RENTED �REM'sS Ea occurrence $ 5O OOO X MED EXP (Any one person) $ N/A PERSONAL &ADVINJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY O JECOT LOC OTHER: GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP/OP AGG $2,000,000 $ C AUTOMOBILE LIABILITY ANY AUTO ALLOWNED SCHEDULED AUTOS AUTOS HIRED AUTOS X NON -OWNED AUTOS EBA0173576 1/01/2016 01/01/201 COMBINED SINGLE LIMIT Ea accident 1,000,000 X BODILY INJURY (Per person) $ BODILY INJURY P (Per accident) $ X PROPERTY DAMAGE Per accident $ $ A X UMBRELLA LIAR EXCESS LIAB X OCCUR CLAIMS -MADE KSVENX162255305 1/01/2016 01/01/201 EACH OCCURRENCE s2 000 OOO AGGREGATE s2,000,000 DED I I RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A 4121092 1/01/2016 01/01/201 X PER OTH- TE_ E.L. EACH ACCIDENT —_ $SOO OOO E.L. DISEASE - EA EMPLOYEE $500000 E.L. DISEASE - POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) As required by written contract or written agreement, the following provisions apply subject to the policy terms, conditions, limitations and exclusions: the City of Fort Collins is included as Additional Insured for work, acts or omissions under the General Liability and Automobile Liability on a primary and non contributory basis and Additional Insured under Automobile Liability but only with respect to liability arising out of the Named Insured's work performed on behalf of the certificate holder. City of Fort Collins Financial Services; Purchasing Division 215 N. Mason Street, 2nd Floor;P.O. 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 ACORD 25 (2014/01) 1 of 1 #S16968781/M16967809 @ 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD RDSZP Client#: 1084369 CONCRSTA ACORDra CERTIFICATE OF LIABILITY INSURANCE DATEY) 12/30/2015 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 endorsement(s). PRODUCER CONTACT Client Manager USI Colorado, LLC C/L PHONE 800 873-8500FA Ed): A/c, No): 303-831-5295 P.O. Box 7050 E-MAIL ADDRESS: den.contractors@usi.biz 80155 800 873-8500 800 873-8500 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Knight Specialty Insurance CO 115366 INSURED INSURER B: Plnnacol Assurance Company 41190 Concrete Stabilization Technologies,lnc INSURER C: Cincinnati Insurance Company 10677 8500 E. Warren Avenue Denver, CO 80231 INSURER D:INSURERS: INSURER F: - COVERAGES CERTIFICATF Nl1MRFR: RFV6tlnN kit IMRFC- 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. LTRR TYPE OF INSURANCE NSRADDLSUBR WVD POLICY NUMBER MM/DDNYYY MM/DDfYYVY LIMITS A X I COMMERCIAL GENERAL LIABILITY CLAIMS -MADE O OCCUR BI/PD Ded:25000 KSVENA160035507 1/01/2016 01/01/2017 EACH OCCURRENCE $1 000000 PREMISES (Ea occunence $50OOO X MED EXP (Any one person) $ N/A PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: I A POLICY I JECTT IF] LOG OTHER: GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP/OP AGG $2,000,000 $ C AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AS AUTS UTOO HIRED AUTOS X NON -OWNED AUTOS EBA0173576 1/01/2016 01/01/2017 COMBINED SINGLE LIMIT Ea accident 1,000,000 XI BODILY INJURY (Per person) $ X BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ /j X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE KSVENX762255305 1/01/2016 01/01/201 EACH OCCURRENCE $2000000 AGGREGATE $2 000 000 DED I I RETENTION$ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / NTER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? a (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A 4121092 1/01 /2016 01/01/201 X PER OTH- E.L. EACH ACCIDENT $SOO OOO E.L. DISEASE - EA EMPLOYEEI $500 000 E.L. DISEASE -POLICY LIMIT 1 $500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) As required by written contract or written agreement, the following provisions apply subject to the policy terms, conditions, limitations and exclusions: the Certificate Holder is included as Additional Insured for Work, acts or omissions under the General Liability and Automobile Liability but only with respect to liability arising out of the Named Insured's work performed on behalf of the certificate holder. City of Fort Collins PO Box 580 Ft Collins, CO 80522-0000 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 (2014/01) 1 Of 1 #S16968780/M16967809 ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD RDSZP