HomeMy WebLinkAboutROCKY MOUNTAIN STONE & CONCRETE FLATWORK LLC - INSURANCE CERTIFICATE (3)DATE (MWDD/YYYY)
ACCOR EP CERTIFICATE OF LIABILITY INSURANCE
6/27/2018
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 Donna Birleffi
NAME:
Professional Risk LLC PH NN ,_Ext): (970) 356-8030 A/C No). (970)356-8032
8213 W.20th St E-MAIL ADDRESS: donna-.birleffi@proriskllc.com
INSURER(51 AFFORDING COVERAGE NAIC #
Greeley CO 80634 INSURER A:Libwrty Mutual Insurance Co
INSURED INSURER s.:Pinnaccil_ Assurance____-________
Rocky Mountain Stone & Concrete Flatwork, LLC INSURERC:
1804 SW loth INSURER0:
INSURER E : _
Loveland CO 80537 INSURERF:
rnvGtzecrc CERTIFICATE NLIMRFP-18-19 All 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.
ILTR TYPE OF INSURANCE A D S VD
LTR
DCYD/YYYY LIMITS
POLICY NUMBER MO OICY EFF MPOLICY
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE X OCCUR
EACH OCCURRENCE
DAMAGE TO RENTED
PREMISES tEa occurrence
$ 1,000,000
$ 300,000
X
BLS58901103 7/26/2018 7/26/2019
MED EXP (Anyone person)
$ 15,000
$ 1,000,000
PERSONAL&ADVINJURY
GEN'L
AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 2,000,000
POLICY JECOT LOC
OTHER:
X
PRODUCTS -COMP/OP AGG
$ _ 2,000,000
$
AUTOMOBILE LIABILITY
COMBINED
Ea accident N L L
$
BODILY INJURY (Per person)
-
$
ANY AUTO
i
BODILY INJURY (Per accident)
$
ALLOWNED I, SCHEDULED
A
NON -OWNED
HIRED AUTOS _ AUTOS
PerOeccidentDAMAGE
-
$
- --
$
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$
AGGREGATE
$
EXCESS LIAB_
CLAIMS -MADE
DED RETENTION $
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y/N
ANY PROPRIETOR/PARTNER/EXECUTIVE r
X TH-
E.L._EACH ACCIDENT
$ 500,000
E.L. DISEASE - EA EMPLOYE
$ 500000
B
MFMEn EXCLUDED? u
(Mandatory ry NH )
N / A
4166544
8/1/2018
8/1/2019
E.L. DISEASE - POLICY LIMIT
$ 500,000
H yes, describe under
DESCRIPTION OF OPERATIONS below
i
I ,
i I �
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
The City of Fort Collins is listed as additional insured as pertains to the General Liabiity policy, per
written contract.
CERTIFICATE HOLDER CANCELLATION
City of Fort Collins
PO Box 580
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
ionne Perez/DP
U 19t3S-2U14 AGUKU GUKVUKA I IUN. All rlgnts reservea.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
INS025 (201401)