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HomeMy WebLinkAbout184254 DURAN EXCAVATING INC - INSURANCE CERTIFICATE (13)DATE (MPNDD/YYYY) Ac" " CERTIFICATE OF LIABILITY INSURANCE 3/22/2016 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 NAME: Kim Case, CIC, CPSR PHOFlood and Peterson (AIC N E t: (970) 506-3213 A/C No: (970)506-6865 PO Box 578 E-MADDRESS: KCase@floodpeterson.com Greeley, CO 80632 INSURER(S) AFFORDING COVERAGE NAICn INSURED INSURERB:Pinnacol Assurance Duran Excavating Inc. INSURERC: 14332 CR 64 INSURERD: Greeley, CO 80631 INSURERE: CnVFRAGFS CFRTIFICATF NUMRFR-2016-2017 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 LT TYPE OF INSURANCE INSDADDL WVDSUBR POLICY NUMBER MMLIDY EYY MM DD YYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ 300,000 X MED EXP (Any one person) $ 10,000 PD Ded: $2,500 DTC08077BO49PHX16 4/9/2016 4/9/2017 PERSONAL & ADV INJURY $ 1, 000, 000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO - POLICY [:K JECT LOC PRODUCTS - COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ A X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS DT8108077B049iND16 4/9/2016 4/9/2017 BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ NON -OWNED X HIRED AUTOS X AUTOS X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 AGGREGATE $_ 5,000,000 A EXCESS LIAB CLAIMS -MADE DED I X RETENTION$ 10,000 $ DTSMCUP8077BO49TIL16 4/9/2016 4/9/2017 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N X PER OTH- STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1,000,000 13 OFRCER/MEMBER EXCLUDED? ❑ (Mandatory in NH) N/A 4110254 1/1/2016 1/1/2017 - E.L. DISEASE - EA EMPLOYE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1 $ 1 000 000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached 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. 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 K Case, CIC, CPSR/APR ACORD 25 (2014/01) INS025 (201401) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD