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HomeMy WebLinkAboutADVANCED UNDERGROUND INC - INSURANCE CERTIFICATE (8)ACORO0 CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 1/4/2018 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 CONTACT NAME: TrueNorth 275 South Main Street _ PHONE FAX � No, ExtJ: 319-366-2723 rvc, No): 319-862-0612 ADORES& certs@truenorthcompanies.com Longmont CO 80502 INSURER(S) AFFORDING COVERAGE NAIC i INSURER A: Charter Oak Fire Insurance Company 25615 INSURED ADVAUND-02 INSURER B: Travelers Indemnity Company 25658 Advanced Underground Inc 10360 East 107th Place INSURERC: Pinnacol Assurance Company 41190 INSURER D: Brighton CO 80601 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: 1046095602 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. IDL R TYPE OF INSURANCE ADSUER POLICY EFF LT POLICY EXP ' LIMITS R POLICY NUMBER MMlDD/YYY MMlDD/YYVY A X COMMERCIAL GENERAL LIABILITY Y C06G870857 1/5/2018 1/5/2019 EACH OCCURRENCE E 1.000,000 CLAIMS -MADE FxI OCCUR DAMAGE To RENTED`__ PREMISES Meoccurrence $500,000 MED EXP (Any one person) E 5,000 PERSONAL & ADV INJURY E 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE E 2,000,000 POLICY FXJECOT- � LOC PRODUCTS •COMP/OP AG E 2,000,000 E OTHER: A AUTOMOBILE LIABILITY 8106G870857 1/5/2018 1/5/2019 COMBINED SINGLE LIMIT Ea accident $ 1 00 000 X BODILY INJURY (Per person) _ E ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident E S B X UMBRELLA LIA B X OCCUR CUP9H164792 1/&2018 1/5/2019 EACH OCCURRENCE E 5,000,000 AGGREGATE b 5,000,000 EXCESS LIAB CLAIMS -MADE DED I X RETENTION 8 1 o 000 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN 4076345 1/1/2018 1/1/2019 X PER OTH- STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? Y N/A E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE (Mandatory in NH) E 1,000,000 It yes, describe under DESCRIPTION OF OPERATIONS below I E.L. DISEASE - POLICY LIMIT E 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS! VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Harvey and Valorie Houston are excluded from Work Comp. If Yes is indicated above for add'I insd forms Gen Liab #CGD316 & CGD604 premises and completed operations, Auto Liab #CAT474 applies. If Yes is indicated above for waiver of subrogation forms Gen Liab #CGD316 Auto Liab #CAT353 and WC #WC000313 04/04 applies. Coverage is extended for work performed and required under written contract with the above named insured. CERTIFICATE HOLDER CANCELLATION City of Fort Collins PO Bx 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 A Ae_ © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD