Loading...
HomeMy WebLinkAboutPIERSON'S CONCRETE CONSTRUCTION CO - INSURANCE CERTIFICATE (3)P526W21a1112 DATE (MMIDOIYYYY) ACORU CERTIFICATE OF LIABILITY INSURANCE 02/03/2016 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 1-303-534-4567 CONTACT NAME: IMA, Inc. - Colorado Division PHONE -(A/C No. EXI), _ _ _ _ _ _ _ _ IA/C. Noll: E-MAIL denaccounttechs@imacorp.com 1705 17th Street ADDRESS: rP• Suite 100 INSURERS AFFORDING COVERAGE NAIL • Denver, CO 80202 _ INSURERA: PINNACOL ASSUR 41190 _-------._.—_... --- INSURED INSURER INSURER B : Piersonrs Concrete Construction CO. INSURER C: PO Box 271248 INSURER D: INSURER E : Fort Collins, CO 80527 INSURER F: rnVFRAr:FS rFRTIFIrATF NIIMRFR• 46023022 RFVISInN NIIMRFR- 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 I TYPE OF INSURANCE ADOL SUBR POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIDDIWYY LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE L-] OCCUR EACH OCCURRENCE E DAMAGE TO RENTED PREMISES (Ea occurrence) E GEN'L MED EXP (Any one person) E PERSONAL d ADV INJURY E AGGREGATE LIMIT APPLIES PER: POLICY E PROJECT- ❑ LOC OTHER: GENERAL AGGREGATE E PRODUCTS - COMPIOP AGG E E AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS COMBINED SINGLE LIMIT Eaccident a E BODILY INJURY (Per person) E BODILY INJURY (Per accident) E PROPERTY DAMAGE Per accident E E UMBRELLA LIAB EXCESS LU1B OCCUR CLAIMS -MADE EACH OCCURRENCE E AGGREGATE E DED F1 RETENTION E E A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE a OFFICERIMEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N I A 4055614 07/01/15 07/01/16 TH z STATUTE ER E.L. EACH ACCIDENT E 1,000,000 E.L. DISEASE - EA EMPLOYEE E 1,000,000 E.L. DISEASE - POLICY LIMIT E 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Fort Collins THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 1190 AUTHORIZED REPRESENTATIVE / /�ff Fort Collins , CO 80522 / //�,i��//��/I USA [` ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD ashmcclain 46023022 00 m W P52NX)281M12 P1NN/ICOL ASSURANCE Piersons Concrete Construction Inc PO Box 271248 Fort Collins, CO 80527 ENDORSEMENT: Blanket Waiver of Subrogation 7501 E Lowry Blvd Denver, CO 80230-7006 303-361-4000 / 800-873-7242 www.pinnacol.com NCCI #: WC000313B Policy #: 4055614 IMA, Inc. 1705 17th Street, Suite 100 Denver, CO 80202 (303) 534-4567 We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us. This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. SCHEDULE To any person or organization when agreed to under a written contract or agreement, as defined above and with the insured, which is in effect and executed prior to any loss. Effective Date: July 1, 2015 Expires on: July 1, 2016 Pinnacol Assurance has issued this endorsement June 17, 2015. Nicholas Brown Underwriter Page 1 of 1 P ISA - 7501 E Lowry Blvd Denver, CO 80230-7006 4055614 41639064 359-B M N L4 0 N