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HomeMy WebLinkAbout389648 A-1 CHIPSEAL COMPANY - INSURANCE CERTIFICATE (15)DATE (MM/DD/YYYY) AC oRo® CERTIFICATE OF LIABILITY INSURANCE 4/30/2018 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 NAME: Deanna Zahn, ACSR Moody Insurance Agency, Inc. . (303) 824-6600 F No: (303)370-0118 PNONE BOSS East Tufts Avenue AIL ADDRESS:deanna.zahnomoodyins.com Suite 1000 INSURE 8 AFFORDING COVERAGE NAIL# Denver CO 80237 INSURERA:Phoenix Insurance Company 25623 INSURED INSURERB:Travelers Prop C'as CO of America 25674 A-1 Chipseal Company, DBA: Rocky Mountain Pavement, INSURERC:Pinnacol Assurance 41190 2505 E. 74th Ave INSURERD:Illinois Union Insurance Company 27960 INSURERE:AGCS Marine Ins Co 22837_ Denver CO 80229 INSURERF: rnvcoAccc CCRTWICATG NIIMRFR•18-19 w/froms RFVISInN NIIMRFR- 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 DDL iv POLICY NUMBER MMIDCD/YYYY MM Y EFF PODDYYYYY L I LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 11000,000 A CLAIMS -MADE Fx_1 OCCUR DTCOOJ30005PHXIB $ 300,000 PREMISES Ea occurrence MED EXP (Any one person) X Additional Insured Status 2/1/2018 2/1/2019 $ 10,000 Applies Only To The Extent $ 11000,000 PERSONAL & ADV INJURY GEN'LAGGREGATE LIMIT APPLIES PER: Provided in Forms GENERAL AGGREGATE $ 2,000,000 PRODUCTS -COMP/OPAGG $ 2,000,000 POLICY a JEa LOC CG D3 16 11/11 & $ OTHER: CG D2 46 08/05 AUTOMOBILE LIABILITY EaMa�dent ED SINGLE LIMIT$ 11000,000 BODILY INJURY (Per person) $ B IANY AUTO AU OS SCHEDULEDAUTOS AUTOS NON -OWNED HIREDAUTOS X AUTOS XDT810OJ30005TILIB 2/1/2018 2/1/2019 BODILYINJURY(Peraccident) $ PROPERTY DAMAGE Per accident $ Co rehesive/Collision Ded. $ 21000 X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10, 000, 000 B EXCESS UAS CLAIMS -MADE DED X RETENTION$ 10,000 $ CUP2J3100431826 2/1/2018 2/l/2019 C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE —] OFFICER/ME BER EXCLUDED? (Mandatory In NH) NIA 4055760 2/1/2018 2/1/2019 X PERSTATUTE ER —' E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEA $ 500,000 E.L. DISEASE - POLICY LIMIT 1 $ 500,000 If yes, describe under DESCRIPTION OF OPERATIONS below I D Pollution Liability CPYG27165825006 2/l/201a 2/1/2019 Umttperoccurence/aggregate 51000,000 E Motor Truck Cargo IMZI93038733 2/1/2018 2/l/2019 Limit. 100,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) Re: 8522 Asphalt Surface Treatment Project - 2018 Renewal City of Fort Collins and their officers, agents, and employees are included as additional insured with respect to General and Autmobile Liability as required by written contract. ULKI II-IUA It HULUtK l A1V l.CLLN 1 IVIY City of Fort Collins 300 Laporte Avenue 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 Zahn, ACSR/DANFLI 16�1 '� e U 19BB-2014 AUUKU UUKVUKA I IUN. All rignts reserve0. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (201401)