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HomeMy WebLinkAboutLUND-ROSS CONSTRUCTORS INC - INSURANCE CERTIFICATE (3)AC"R" CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 12/29/2015 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 endorsements . PRODUCER The Harry A. Koch Co. P.O. Box 45279 Omaha NE 68145-0279 CONTACT NAME: PHONE 402-861-7000 FAX _-- � Nol E-MAILA/C INSURERS AFFORDING COVERAGE NAIC # INSURER A:The Cincinnati Insurance CO 10677 INSURED INSURER B:The Cincinnati Indemnity CO 23280 Lund -Ross Constructors, Inc. 4601 F Street INSURER C: P.O. Box 3688 INSURER D INSURER E t Omaha NE 68103 INSURER F : COVERAGES CERTIFICATE NUMBER: 227549056 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 ADDLISUBIR INSD WVD POLICYNUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIALGENERALLIABILITY CLAIMS -MADE X� OCCUR CPP0816276 1/1/2016 1/1/2017 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence)$500,000 _ MED EXP (Any one person) $10,000 - PERSONAL& ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY a 1ECOT- LOC OTHER: GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP/OP AGG $2,000,000 $ A AUTOMOBILE X X LIABILITY 1 ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIREDAUTOS x NON -OWNED AUTOS CPA0816276 1/1/2016 1/1/2017 EaaccidenWIN _Lt SINGLE LIMIT $1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE CPP0816276 1/1/2016 1/1/2017 EACH OCCURRENCE $10,000,000 AGGREGATE $10,000,000 DED RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑N IN/ (Mandatory in NH) If ves, describe under DESCRIPTION OF OPERATIONS below A WC186461801 1/1/2016 1/1/2017 PER oTH- X STATUTE ER E.L. EACH ACCIDENT s500,000 E.L. DISEASE - EA EMPLOYEE $500,000 " E.L. DISEASE - POLICY LIMIT 1 s500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION City of Fort Collins PO Box 580 Fort Collins CO 80522-0580 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 © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD