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HomeMy WebLinkAbout184254 DURAN EXCAVATING INC - INSURANCE CERTIFICATE (12)A� "© CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 12/23/2015 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 Flood and Peterson PO Box 578 Greeley, CO 80632 CONTACT Kim Case NAME: PHONE (g JO) 506-3213 A/C No: (970)506-6665 ADDRESS,KCase@floodpeterson.com INSURERS AFFORDING COVERAGE NAIC# INSURERA:Travelers Insurance Company INSURED Duran Excavating, Inc. 14332 CR 64 Greeley, CO 80631 INSURERB:Pinnacol Assurance 41190 INSURERC: INSURER D: INSURER E: INSURER F : nOVFRAnFS CFRTIFICATF NIIMRFR-CL15122308045 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 SUBR POLICY NUMBER POLICY EFF MM/ D YYYY POLICY EXP MM/ DYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 11000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TRENTED PREMISES Ea occurrence $ 300, 000 A CLAIMS -MADE aOCCUR DTC08077BO49IND15 /9/2015 /9/2016 MED EXP (Any one person) S 10,000 PERSONAL & ADV INJURY $ 1,000,000 X PD Ded: $2,500 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 $ POLICY X PRO LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 1,000,000 BODILY INJURY (Per person) $ A X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS DT8108077BO49TIL15 /9/2015 /9/2016 BODILY INJURY (Per accident) $ ROPERTY (pera cidentDAMAGE $ X HIRED AUTOS N AUUTOSWNED X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 A EXCESS LIAB CLAIMS -MADE DTSMCUP8077BO49TIL15 /9/2015 /9/2016 DED X IRETENTION $ 10,000 1 $ B WORKERS COMPENSATION 4110254 1/1/2016 /1/2017 X WC STATU- OTH - TOR7 AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 11000,000 OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) N / A E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1 C 0 0 , 0 v 0 If yes, describe under DESCRIPTION OF OPERATIONS beiow DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Project: 8125 Intersection Improvements at Vine & Shields State of Colorado and the City of Fort Collins are included as Additional Insured as required by written contract with respects to liability arising out of work performed by the named insured on the General and Automobile Liability. CERTIFICATE HOLDER CANCELLATION City of Fort Collins Purchasing Division 215 North Mason St. 2nd Floor 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 K Case, CIC, CPSR/APR ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. INS025 (201005),01 The ACORD name and logo are registered marks of ACORD