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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) 01988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD