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HomeMy WebLinkAboutPLAINS CONTRACTING LLC - INSURANCE CERTIFICATEAiC"R" CERTIFICATE OF LIABILITY INSURANCE 4/ ATE(M /DDIYYYY) 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 rArthur his certificate does not confer rights to the certificate holder in lieu of such endorsements . DUCER CONTACT NAME: J. Gallagher Risk Management Services, Inc.303 444-4666 17th Street, Suite #675 yR— nver CO 80202 ADDRE-MAESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Central Mutual Insurance Company 20230 INSURED INSURERS: Underwriters at Lloyd's, London 11230 Plains Contracting LLC INSURER c: Pinnacol Assurance Company 41190 601 Salida Way, Unit 134 INSURERD: Aurora, CO 80011 INSURER E : CnVFRAC,FS rF:0TIFIP:ATG N11111ARFD• 1n41597184 DCVIctnlll RII IRAD VD. 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 LTR I TYPE OF INSURANCE INSD WVD POLICY NUMBER POLICY EFF MM/DDIYYYY POLICY EXP MIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLP 9597739 4/12/2018 4/12/2019 EACH OCCURRENCE $1,000,000 CLAIMS -MADE ❑X OCCUR PREMISES Eaa oocccurrD $300,000 MED EXP (Anyone person) $5,000 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POLICY PRO- ❑ JECT LOC PRODUCTS •COMP/OP AGG $2,000,000 X $ OTHER: XCU Included A AUTOMOBILE LIABILITY BAP 9597738 4/12/2018 4/12/2019 Ea accident $ 1,000,000 X BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS ) BODILY INJURY (Per accident $ HIRED NONOWNEDROPFRTY AUTOS ONLY X AUTOS ONLY X DARfAGE Per accident $ Medical Payment $5,000 A X UMBRELLA LIAB X OCCUR CXS 9597740 4/12/2018 4/12/2019 EACH OCCURRENCE $5,000,000 AGGREGATE $5,000,000 EXCESS LIAB CLAIMS -MADE DIED X I RETENTION$10,000 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? NIA 4166291 8/1/2017 8/1/2018 X I STATUTE OERH E.L. EACH ACCIDENT — $1,000,000 -_..-- (Mandatory in NH) If yyes, describe under E.L. DISEASE - EA EMPLOYEE $1,000,000 — $1,000,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT B A Errors & Omissions Installation Floater Equipment Floater ANE139370817 CLP 9597739 10/3112017 10/31/2018 'Aggregate Limit $2,000,000 4/12/2018 4/12/2019 Limit $1,000,000 Leased Equipment $50,000 DESCRIPTION OF OPERATIONS / LOCATIONS ! VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Insurer A; CXS 9597740 - Umbrella Liability is Follow -Form on General Liability and Auto Liability. CERTIFICATE HOLDER CANCELLATION City of Fort Collins 281 N. College Avenue Fort Collins CO 80524 USA 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 © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD