HomeMy WebLinkAboutPIERSON'S CONCRETE CONSTRUCTION CO - INSURANCE CERTIFICATE (5)P52Wa128002
[_DATE (MMIDDIYYYY)
" ACOR" CERTIFICATE OF LIABILITY INSURANCE 0
6/20/2018
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 have ADDITIONAL INSURED provisions or 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:
INA, Inc. - Colorado Division PHONE FAX
(AIC No. : —__ W. N01:
E-MAIL
1705 17th Street ADDRESS: denaccouattechaQimncorp.cout
Suite 100 INSURER(S)AFFORDING COVERAGE NAIC0
Denver, CO 80202 INSURERA: PIMU=L ASSUA 41190
INSURED INSURER B :
Pierson•s Concrete Construction Co.
INSURER C
PO Box 271248 INSURERD:
INSURER E :
Fort Collins, CO 80527 1 INSURER F:
111C1l ATC a111"MC0• SQ17nnnd RFVISIr11J IM11YRCR-
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 SUER POLICY NUMBER MMIDDY EFF MMIDDY EXP LIMITS
LTR
COMMERCIAL GENERAL LIABILITY
CLAIMS-MADE I _ J OCCUR
EACH OCCURRENCE
$
AMACETO REN—fiff-
PREMISES (Ea occurrence)
Z
MED EXP (Any one person)
f
PERSONAL 6 ADV INJURY
$
GENT AGGREGATE LIMIT APPLIES PER:
POLICY n PRO- LOC
OTHER:
GENERAL AGGREGATE
f
PRODUCTS - COMP/OP AGGJECT
>i
$
AUTOMOBILE LIABILITY
ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
COMBINED SINGLE LIMIT
Ee accident)_____.
$
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
f
PROPERTY DAMAGE
pa k.0
$
t
UMBRELLA LIAR
EXCESS LIAB
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
i
AGGREGATE
8
DED RETENTION E
$
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANYPROPRIETORIPARTNERIEXECUTIVE
OFFICERIMEMBEREXCLUE
(Mandatory In NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
IN1 A
4055614
07/01/18
07/01/19
Y PTATUTE OTH-
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYEE
i 1, 000, 000__
E.L. DISEASE - POLICY LIMIT
i 1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
1aKIIrIGAIt 111.11LUICK a,nna.«�nuvn
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
�ity of Fort Collins THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
PO BOX 1190 AUTHORIZED REPRESENTATIVE ,//,w
Fort Collins , CO 80522/
USA C
U 19813-ZOI3 AI:UKU UUKYUKA I IUN. AU ngnis reserved
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
epmaestas
53130004
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