HomeMy WebLinkAbout601609 MYERS & SONS CONSTRUCTION LP - INSURANCE CERTIFICATE (8)AL ® 72/21/2018
(MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE
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).
F
CER CONTACT
NAME:
dale-Alliant Ins Svc Inc PHONEFAX
arle Ovington Blvd Ste 700 aMAL - 516-414-8900 A/c No:
dale NY 11553 ADDRESS:
INSURER A: Travelers Indemnity Company 25658
INSURED STERCON-04 INSURERS; Travelers Property Casualty Co of Amer 25674
Myers & Sons Construction, L.P.
4600 Northgate Blvd., Suite 100 INSURERc: Berkshire Hathaway Specialty Insurance Company 22276
Sacramento, CA 95834 INSURER D :
I INSURER E :
nOVFRAr;FR rFRTIFICATF NUMBER: 14n3R15nti9 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 DOCUMEN-f 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.
EXP
INSR ADDLTYPE OF INSURANCE INSD WVQ SUER POLICY NUMBER MMI DPOLICY/YYYY MM/ DEFF Y/YYYY LIMITS
LTR
A
X
COMMERCIAL GENERAL LIABILITY
VTC2K-CO-2E97127A-IND-18
3/1/2018
3/1/2019
EACH OCCURRENCE
$ 2,000,000
CLAIMS -MADE � OCCUR
DAMAGE TO RENTED
PREMISES Ea occu rents
$ 300,000
X
MED EXP (Any one person)
$10,000
Contractual Liab
PERSONAL & ADV INJURY
$ 2,000.000
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 4,000,000
POLICY PRO-
JECT ❑ LOC
PRODUCTS - COMP/OP AGG
$ 4,000,000
$
OTHER:
B
AUTOMOBILE
LIABILITY
VTC2J-CAP-2E971281-TIL-18
3/1/2018
3/1/2019
COMBINED SINGLE LIMIT
Ea accident
$ 2,000,000
X
BODILY INJURY (Per person)
$
ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
BODILY INJURY (Per accident)
$
X
PROPERTY DAMAGE
Per accident)$
NON -OWNED
HIRED AUTOS X AUTOS
C
X
UMBRELLA LIAB
X
OCCUR
47-XSF-303345-02
3/1/2018
3/1/2019
EACH OCCURRENCE
$ 25,000,000
AGGREGATE
$ 25,000,000
EXCESS LIAB
CLAIMS -MADE
DED X RETENTION $ sl o ono
$
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
VTRJ-UB-2E971268-18
3/1/2018
3/1/2019
X PER OTH-
STATUTE ER
ANY PROPRIETOR/PARTNER/EXECUTIVE
E.L. EACH ACCIDENT
$ 2,000,000
OFFICER/MEMBER EXCLUDED? ❑
N / A
(Mandatory in NH)
E.L. DISEASE - EA EMPLOYEE
$ 2,000,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$ 2,000,000
7
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Re: Horsetooth & College Intersection Improvements
City of Fort Collins and Colorado Department of Transportation are included as Additional Insured on a Primary and Non -Contributory basis as respects
General Liability, Automobile Liability and Umbrella Liability as required by written contract. Waiver of Subrogation is included and applies in favor of the
Additional Insureds as required by written contract. Thirty (30) Days Notice of Cancellation applies.
rFRTIFIrATF I-Ir)I nFR rANrFI I ATION
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.
215 North Mason St., 2nd Floor
AUTHORIZED REPRESENTATIVE
PO Box 580
Fort Collins CO 80522
U 1988-ZU14 AGUKD GUKNUKA I IUN. All rlgnts reservect.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD