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HomeMy WebLinkAbout389648 A-1 CHIPSEAL COMPANY - INSURANCE CERTIFICATE (16)7TE (MM/DDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 29/2018 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 Deanna Zahn ACSR NAME: Moody Insurance Agency, Inc. PHO N (303) 824-6600 Fv No: (303)370-0118 8055 East Tufts Avenue E-MADDRESS:deanna.zahn@moodyins.com Suite 1000 INSURERS AFFORDING COVERAGE NAIC 11 Denver CO 80237 INSURERA:Phoenix Insurance Company 25623 INSURED INSURER B :Travelers Prop Cas CO Of America 25674 A-1 Chipseal Company, DBA: Rocky Mountain Pavement, INSURERC:Pinnaeol Assurance 41190 2505 E. 74th Ave INSURERD:Illinois Union Insurance Comvanv 27960 Denver CO 80229 I INSURER F : I COVERAGES CERTIFICATE NUMBER:18-19 w/froms 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM D MM D X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE EXXOCCUR DTCOOJ30005PxX18 DAMAGE TO RENTED PREMISES Ea occurrence $ 300,000 MED EXP (Any one person) $ 10,000 X Additional Insured Status 2/1/2018 2/1/2019 PERSONAL & ADV INJURY $ 1, 000 , 000 Applies Only To The Extent GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 Provided in Forms POLICY JECOT- LOC CG D3 16 11/11 & PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: CG D2 46 08/05 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ B X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS X DT810OJ30005TILIB 2/1/2018 2/1/2019 BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ X HIRED AUTOS X NON -OWNED AUTOS Com rehesive/Collision Ded. $ 2,000 X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10,000,000 B EXCESS LIAR CLAIMS -MADE DE D I X RETENTION$ 10,000 _ $ CUP2J3100431826 2/1/2018 2/1/2019 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN X STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 500,000 C OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) N I A 4055760 2/1/2018 2/1/2019 E.L. DISEASE - EA EMPLOYEq $ 500,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1 $ 500,000 D Pollution Liability CPYG27165825006 2/1/2018 2/1/2019 Limit peroccurence/aggregate 1,000,000 E Motor Truck Cargo MZI93038733 2/1/2018 2/1/2019 Limit: 100,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Fort Collins is listed as additional insured in respect to General Liability and Auto Liability. FE HOLDER 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 D Zahn, ACSR/DANFLI 16&1 � ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD I NS025 (201401)