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HomeMy WebLinkAbout122685 MARTIN & SONS EXCAVATING INC - INSURANCE CERTIFICATE (3)® F__DATE /Y TE (MWDDYYY) ACC)OR" �CERTIFICATE OF LIABILITY INSURANCE 6/29/2017 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 Dana Stewart, CIC, CISR NAME: Flood and Peterson PNONE , (970) 266-7149 a (970)330-1867 PO Box 578 E-MADDRESS: DStewart0floodpeterson.com INSURER AFFORDING COVERAGE NAIC If Greeley CO 80632 INSURERA:Cincinnati Insurance Co 10677 INSURED INSURERB:Pinnacol Assurance 41190 Martin & Sons Excavating, Inc. INSURER C:Travel era Insurance Co 18868 Weld County Road 3 INSURERD: INSURER E : Berthoud CO 80513 INSURERF: COVFRAr,FS CERTIFICATE NUMRER-Master 2017-18 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 POLICY EFF M D YY POLICY EXP YYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE FxI OCCUR PREMISES Ea occurrence $ 500,000 MED EXP (Any one person) $ 10,000 EPP0258632 7/1/2017 7/1/2016 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO ­ POLICY FX—] JET 7 LOC PRODUCTS - COMP/OP AGG $ 2,000,000 Employee Benefits $ 3,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 11000,000 BODILY INJURY (Per person) $ A X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS EPP0258632 7/1/2017 7/1/2018 BODILY INJURY (Per accident) $ Per d DAMAGE $ X HIRED AUTOS X AUTOS NON -OWNED Underinsured motorist $ 1,000,000 X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 A EXCESS LIAR CLAIMS -MADE DED I X RETENTION 0 $ EPP0258632 7/1/2017 7/1/2018 WORKERS COMPENSATION EMPLOYERS' LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE XAND STATUTE I I ER E.L. EACH ACCIDENT $ 11000,000 B OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N % A 1316630 7/1/2017 7/1/2018 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below C Excess Liability ZUP-51M34359-17-NF 7/1/2017 7/1/2018 Each Occurrence.Aggregate 3,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) l;LH I WII A I t HULUtH t.Arvl.tLLA I IVIV (970)224-6134 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 P Stehle, CISR/PSTEHL Wl.� 12 _S�f ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (201401)