The URL can be used to link to this page

Home My WebLink AboutROBERTS EXCAVATION CORPORATION - INSURANCE CERTIFICATE (15)--� ROBEEXC-01 CWATSON ACORO DATE (MM/DDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 3/28/2016 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: Rhonda_ Fisher _ TrueNorth PHONE FAX PO Box 847 (A/C, No, Eli:(303) 776-6122 (ac,No). (303) 776-"95 Longmont, CO 80502 ADDARESS: INSURERS) AFFORDING COVERAGE NAIC # INSURERA:Westfield Insurance Company 24112 INSURED INSURER B : Roberts Excavation Corp. INSURERC: _ 1801 1 St. St INSURER D : Berthoud, CO 80513 INSURERE: COVFRAr.FS CERTIFICATE NLIMRER- REVISION NLIMBER- 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 TYPE OF INSURANCE ADDL SUBR POLICPOLICY EXP LTR INSD WVD POLICY NUMBER (MM/DDY EFF (MM/DD/YYYY1 LIMITS LITY A X COMMERCIAL LIO�CUR RENCE EACH OCCURRENTED $ 1,000,00 — ----- S-MADEGENERAL CLAX TRA3889121 04/01/2016 04/01/2017 PREM SES jEa occurrence $ 500r00 $ 10,000 MED EXP (Arty one person) PERSONAL 8 ADV INJURY $ 1,000,00 $ 2,000,000 G,(EN'LL AGGREGATE APPLIES : i�, GENERAL AGGREGATE IPE IMT PRODUCTS - COMP/OP AGG . $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 A X ANY AUTO TRA3889121 04/01/2016 04/01/2017 BODILY INJURY (Per person) $ ALL OWNED SCHEDULED i BODILY INJURY (Per accident) $ AUTOS AUTOS NON -OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident _ -. $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,00 A EXCESS LIAB CLAIMS -MADE TRA3889121 04/01/2016 04/01/2017 AGGREGATE ate Aggregate gJ g $ $ 2,000,000 000 DED X RETENTION$ 10,000 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE _ PER O H- STATUTE ER E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ NIA - -------- ---- (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ Ues, describe under -- - _ -- SCP.!PT!ON OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION City of Fort Collins 215 N Mason St Fort Collins, CO 80521 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 44 © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD