Loading...
HomeMy WebLinkAboutNIXCAVATING INC - INSURANCE CERTIFICATE (4)ACC " CERTIFICATE OF LIABILITY INSURANCE DATE (M MIDD/YYYY) 12/18/2015 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 Karole Peters NAME: Ewing -Leavitt Insurance Agency Nt o Ex (970) 679-7355 A No: (866)237-2178 4025 St. Cloud Dr. E-MAIL ADDRESS: karole-peters@leavitt.com Suite 100 INSURERS AFFORDING COVERAGE NAIC # Loveland CO 80538 INSURERA:Cincinnati Insurance Co 10677 INSURED INSURER B :Pinnacol Assurance 41190 Nixcavating, Inc. INSURER C : P . 0. Box 2232 INSURER D : I Longmont CO 80501 I INSURER F : COVERAGES CERTIFICATE NUMBER:16-17 WC Update 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 MM/DPOLI D/YYYY MMIDDNYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EPP0124847 10/l/2015 ' 10/1/2016 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE 51 OCCUR A AG To PREM SES (Ea oNcur ante $ 500 , 000 X MED EXP (Any one person) $ 10,000 Blkt Additional Insured X Blkt Waiver of Subro PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY F_x1 jRO LOC PRODUCTS - COMP/OPAGG $ 2,000,000 $ OTHER: A AUTOMOBILE LIABILITY EPP0124847 10/1/2015 10/1/2016 COMBINED SINGLE LIMIT Ea accident $ 1, 000, 000 X BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ X PROPERTY DAMAGE Per accident $ NON -OWNED HIRED AUTOS % AUTOS X $ Blkt Al I X Blkt WOS A X UMBRELLA LIAB X OCCUR EPP0124847 10/1/2015 10/1/2016 EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 EXCESS LIAB CLAIMS -MADE DIED I X RETENTION $ 0 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y 1 N ANY PROPRIETOR/PARTNER/EXECUTIVE 2113100 Blanket Waiver of 1/1/2016 1/1/2017 X IPER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) NIA Subrogation Included E.L. DISEASE - EA EMPLOYE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 A � Leased or Rented Equipment EPP0124847 10/1/2015 10/1/2016 Limit with $500 Deductible $200, 000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Fort Collins is additional insured on the general liability policy as regards work performed by the insured. CERTIFICATE HOLDER CANCELLATION City of Fort Collins PO 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 role Peters/KAPETE © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (201401)