HomeMy WebLinkAboutON DEMAND CONCRETE - INSURANCE CERTIFICATE 2018-2019ACORo® CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
02/22l2018
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
CONTACT Kylie Carey, CISR
NAME:
Flood and Peterson
PHONE (970) 266-7148 FAX 970
A/C No Ext : AlC, No : ( ) 506-6845
PO Box 578
E-MAIL KCarey@floodpeterson.com
ADDRESS:
INSURERS) AFFORDING COVERAGE
NAIC #
Greeley CO 80632
INSURER A: Westfield Insurance Company
24112
INSURED
INSURER B : Plnnacol Assurance
41190
On Demand Concrete
INSURER C : Travelers Property Casualty Company
36161
1501 Backhoe Road
INSURER D :
INSURER E :
Loveland CO 80537
INSURER F:
COVERAGES CERTIFICATE NUMBER: CL1822222121 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.
INSR
LTR
TYPE OF INSURANCEAUL)LIbUI
INSD
WVD
POLICY NUMBER
POLIC EFF
MM/DD/YYYY
POLICY EXP
MM/DD/YYYY
LIMITS
X
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
CLAIMS -MADE � OCCUR
EN
PREMISES Ea occurrence
$ 500,000
MED EXP (Any one person)
$ 5,000
PERSONAL & ADV INJURY
$ 1,000,000
A
TRA5246965
03/01/2018
03/01/2019
GENL AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 2,000,000
POLICY X PRO JECT LOC
PRODUCTS -COMP/OP AGG
$ 2,000,000
Employee Benefits
$ 1,000,000
OTHER:
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
Ea accident
$ 1,000,000
X
BODILY INJURY (Per person)
$
ANY AUTO
A
OWNED SCHEDULED
AUTOS ONLY AUTOS
TRA5246965
03/01/2018
03/01/2019
BODILY INJURY (Per accident)
$
X
PROPERTY DAMAGE
(Per accident
$
HIRED NON -OWNED
AUTOS ONLY X AUTOS ONLY
Medical payments
$ 5,000
X
UMBRELLA LIAB
X
OCCUR
EACH OCCURRENCE
$ 5,000,000
AGGREGATE
$ 5,000,000
A
EXCESS LAB
CLAIMS -MADE
TRA5246965
03/01/2018
03/01/2019
DED I X1 RETENTION $ 0
$
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY v / N
ANY PROPRIMBERlPXCLUDED? ECUTIVE
OFFICER/MEMBER EXCLUDED.
(Mandatory in NH)
N / A
4069771
03/01/2018
03/01/2019
PER OTH-
X STATUTE ER
E.L. EACH ACCIDENT
$ 1,000, 000
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
1,000,000
$
C
Leased/Rented Equipment
411594650
03/01/2018
03/01/2019
$70,000 Limit
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Certificate holder is included as Additional Insured as required by written contract but only as respects to liability arising out of work performed by the named
insured. Waiver of subrogation applies.
L;tH I IFIL:A I t HULUtH L;ANL:tLLA I IUN
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.
P.O. Box 580
AUTHORIZED REPRESENTATIVE
Fort Collins CO 80522Y
ACORD 25 (2016/03)
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