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Home My WebLink AboutTROY FORMING CONCRETE INC - INSURANCE CERTIFICATE (6)1 ® ACORO CERTIFICATE OF LIABILITY INSURANCE `�. [__DATE (MMIDDIYYYY) 3/29/2018 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 endorsements . PRODUCER Moody Insurance Agency, Inc. 8055 East Tufts Avenue Suite 1000 Denver CO 80237 CONTACT Leigh Pullen _ PHONN (303) 824-6600 FAX No: (303)370-0118 ADMDRESS:leigh.Pullen@moodyins.com INSURERS AFFORDING COVERAGE NAIC # INSURERA:United Specialty Ins Co 12537 INSURED Troy Forming Concrete, Inc.; Denver Caisson Drilling, Inc. 998 Salida Way Aurora CO 80011 INSURER B :American Select Insurance Co 19992 INSURERC:Pinnacol Assurance _ 41190 INSURERD: INSURER E INSURER F : r,.1 0 /1 0 XT_ c RFVICIr1N NI IMRFR• l+V Y GRf1V GJ — - 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 TYPE OF INSURANCE ADDL iNqn SUER i - - - POLICY NUMBER POLICY EFF MM DNYYY POLICY EXP LIMITS MM D X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A f CLAIMS -MADE I� OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 50,000 MED EXP (Any one person) $ Excluded ATNATL1881114 4/1/2018 4/1/2019 PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS-COMP/OPAGG $ 2,000,000 PRO- POLICY JECT El LOCF1 $ OTHER: AUTOMOBILE LIABILITY EOaMaBlcNdeDISINGLE LIMIT $ 1,000,000 BODILY INJURY (Per person) $ B X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS X X NON -OWNED HIRED AUTOS AUTOS C2II43784429 4/1/2018 4/1/2019 BODILY INJURY (Per accident) $ PeOa cdentDAMAGE $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ $ EXCESS LIAB CLAIMS -MADE AGGREGATE DIED I I RETENTION $ WORKERS COMPENSATION $ PER OTH- X .STATUTE ER $ 1,000,000 AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE I� E.L. EACH ACCIDENT $ 1,000 000 C OFFICER/MEMBEREXCLUDED? U (Mandatory in NH) NIA 4103394 4/1/2018 4/1/2019 E.L. DISEASE - EA EMPLOYEd - $ 1,000,000 If gs describe Under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT _T DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLUEK %,Mill%, ^II"I` City of Fort Collins P.O. Box 580 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 Leigh Pullen/LEIPUL %& 1V00'LV 14 /A%,Vr%U a.Vrcr Wr I IVIll. r�II I IyIIa� I�aa�`..• ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (201401)