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HomeMy WebLinkAboutROBERTS EXCAVATION CORPORATION - INSURANCE CERTIFICATE (17)/ T ® ACOR" CERTIFICATE OF LIABILITY INSURANCE `....-� DATE (MM/DD/YYYY) 5/22/2018 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 Olson & Olson Ltd 5655 S Yosemite Street #200 Greenwood Village CO 80111 CONTACT NAME: PHONE FAX /C No EXc : 303-867-2055 A/c No): 303-867-2074 WC, ADDRIESs: o2@olsonandolson.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Westfield National Ins CO 24120 INSURED ROBER-2 Roberts Excavation Corporation Roberts Excavating INSURER B : Plnnacol Assurance 41190 -- INSURER C 1801 1st Street INSURER D : INSURER E : Berthoud CO 80513 INSURER F : COVERAGES CERTIFICATE NUMBER: 1646914626 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. INSRPOLICY LTR TYPE OF INSURANCE ADDL SUBR, POLICY NUMBER EFF MWDD/YYYY POLICY EXP MWDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY TRA9707469 4/1/2018 4/1/2019 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE %� OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 500.000 MED EXP (Any one person) $ 10,D00 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 � PRO - POLICY LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER A AUTOMOBILE LIABILITY TRA9707469 4/1/2018 4/1/2019 COMBINED INGLE LIMIT Ea accidentS $1,000,000 BODILY INJURY (Per person) $ X ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS PROPERTY DAMAGE Per accident $ X AUTOS NON -OWNED HIRED AUTOS AUTOS A X UMBRELLA LIAB X OCCUR TRA9707469 4/1/2018 4/1/2019 EACH OCCURRENCE $3,000,000 AGGREGATE $ 3,000,000 EXCESS LIAB CLAIMS -MADE rDED—FX7 RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/ N ANY PROPRIETOR/PARTNER/EXECUTIVE 3241433 6/1/2018 6/1/2019 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) 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 / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate Holder and those listed below(if any) are Additional Insureds as respects General Liability and Umbrella Liability on a Primary and Non -Contributory basis, and Auto Liability only if required by written contract or agreement and coverage applies only as respects work performed by the Insured for the Additional Insureds. All coverage terms, conditions, and exclusions of the policy apply. The Worker's Compensation, General Liability, Auto Liability, and Umbrella Liability policies include a Waiver of Subrogation in favor of the Additional Insureds only if required by written contract or agreement. 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 "141"a © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD