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HomeMy WebLinkAboutPIERSON'S CONCRETE CONSTRUCTION CO - INSURANCE CERTIFICATE (6)P52t"28002 1 DATE (NIMIDDIYYYY) ACC)nv CERTIFICATE OF LIABILITY INSURANCE 06/20/2018 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:_ _ IDEA, Inc. - Colorado Division PHONE FAX ANC No. Lop WC. Nor 1705 17th Street ADDRIE : denaccouattecheQimacorp.com Suite 100 INSURERSJAFFORDINGCOVERAGE NAIL• Denver, CO 80202 INSURERA:UNITED SPECIALTY INS CO (A-T Specialty) 12537 INSURED INSURERS: 2MPLOYSRS NOT CAS CO 21415 Pierson's Concrete Construction Co. INSURER CPINNACOL ASSUR 41190 PO BOX 271248 INSURERD: INSURER E : Fort Collins, CO 80527 INSURERF: CAVFRACAFS CFRTIFICATF NUMRFR- 53130466 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 NVIDSUBIR - POLICY NUMBER MMPOLICY POLICY EXP LTR ONM MMIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY ATHATL1871111 04/10/18 04/10/19 EACH OCCURRENCE E 1,000,000 CLAIMS -MADE LXJ OCCUR PREMISES Eat occurrence)_ $ 50,000 X MED EXP (Any one person) f Excluded BI/PD Ded: $5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: _ POLICY X JET D LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: B AUTOMOBILE LIABILITY 5X4544719 04/10/18 04/10/19 COMBINED SINGLE LIMIT (Ea accident j 1,000,000 BODILY INJURY (Per person) $ X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE ARM accideng. $ -- A UMBRELLALIAB X OCCUR BTN1874539 04/10/18 04/10/19 EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 X EXCESS LIAR CLAIMS -MADE DED RETENTION $ C AND EMPLOYERS' LIABILITY AND EMPS YERS'LOM SATIONILIT ANYPROPRIETOR/PARTNER/EXECUTIVE -1 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) NIA 4055614 07/01/18 07/01/19 X If STAT TE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is requlred) City of Fort Collins: for Pierson?s Concrete Summer BBQ 2017 City of Fort Collins is included as Additional Insured on the General Liability Policy if required by written contract or agreement and with respect to work performed by Insured subject to the policy terms and conditions. It HULUtH City of Fort Collins PO BOX 1190 Fort Collins , CO 80522 ACORD 25 (2016103) spmaestas 53130466 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 /,& USA C • ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 0, �o O N o I n 7z W