HomeMy WebLinkAboutS2CR INC DBA FRONT RANGE EXCAVATION - INSURANCE CERTIFICATE (5)A�ORDa
CC CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DDlYYYY)
03/02/2018
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 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
this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER
NTAEr Trish Preuit
NAME:
PHONE (970) 356-0123 (970) 330-1867
A/C No Ext : A/C, No):
Flood and Peterson
E-MAIL s: TPreuit@Floodpeterson.com
ADDRE
PO Box 578
INSURER(S) AFFORDING COVERAGE
NAIC 8
INSURER A: Pinnacol Assurance
41190
Greeley CO 80632
INSURED
INSURER B :
INSURER C :
S2cr, Inc., DBA: Front Range Excavation
INSURER D :
4411 West County Road 52e
INSURER E :
INSURER F:
Laporte CO 80535
cnVrQAnrc CFRTIFIrOTF NtIMRFR- CL183222298 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
INSD
WVD
POLICY NUMBER
MM/DD/YYYY
MM/DDNYYY
LIMITS
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$
CLAIMS -MADE OCCUR
PREMISES Ea occurrence
$
MED EXP (An one person)$
PERSONAL & ADV INJURY
$
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$
PRODUCTS - COMP/OP AGG
$
POLICY ❑ JECT PRO ❑ LOC
$
OTHER:
AUTOMOBILE LIABILITY
COMBINED IN LE LIMIT
(Ea accident
$
BODILY INJURY (Per person)
$
ANY AUTO
BODILY INJURY (Per accident)
$
OWNED SCHEDULED
AUTOS ONLY AUTOS
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
PROPERTY DAMAGE
Per accident
$
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$
HCLAIMS-MADE
AGGREGATE
$
EXCESS LIAR
DED I I RETENTION $
$
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
NIA
1370000
04/01/2018
04/01/2019
PER OTH-
PERT
STATE ER
E.L. EACH ACCIDENT
1,000,000
$
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000If
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
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)
CER I It-ICA I E HULUEH
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS.
PO Box 580
AUTHORIZED REPRESENTATIVE
Fort Collins CO 80522 1
U 1958-2015 ACVHU CUHFUHAI IUN. AU rigms reservea.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD