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Home My WebLink AboutMETRO PAVERS INC - INSURANCE CERTIFICATE (8)A� �® CERTIFICATE OF LIABILITY INSURANCE D/YYYY) F9/27/2017 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 endorsements . PRODUCER TrueNorth 275 South Main Street, Ste 100 Longmont CO 80502 CONTACT NAME:- TrueNorth Risk Mgmt_CSG-CO _ PHONE 720-491-5411 FAx 303-776 5495 (Arc. No, Ext)_ E-MAIL certs@truenorthcompanies.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A:Pinnacol Assurance CO_ nlpa y____ 41190 INSURED METRPAV-06 INSURER B: United Fire & Casualt;/ Compapy____ 13021 Metro Pavers, Inc INSURER c:Travelers Property Casualty Co of America 25674 PO Box 601 Henderson CO 80640 INSURERD: INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER: 98212096 REVISION NUMBER_ THIS 15 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. INS R TYPE OF INSURANCE POLICY EFF POLICY EXP LIMITS LTR INSD POLICY NUMBER MMIDD/YYYY MMIDD/YYYY B X COMMERCIAL GENERAL LIABILITY Y 60496691 10/1/2017 10/112018 EACH OCCURRENCE $1,000,000 CLAIMS -MADE �X OCCUR AMAGE TORENTEU PREMISES Ewa occurrence $500,000 MED EXP (Any one person) $5,000 PERSONAL & AD_V INJURY $1,000,000 AGGREGATE LIMIT APPLIES PER: GENERAL_ AGGREGATE $2,000,000 GEN'L POLICY ❑X PE a ❑X LOC PRODUCTS - COMP/OP AGG $ 2,000,000 Prop Damage Ded $$500 OTHER: B AUTOMOBILE LIABILITY 60496691 10/1/2017 10/1/2018 COMBINED SINGLE LIMI I Ea accident __ $1,000,000 BODILY INJURY (Per person) $ X ANY AUTO X OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON OWNED AUTOS ONLY X AUTOS ONLY BODILY INJURY (Per accident) $ ROPER7YDAlUAGI�-- $ B C X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE 60496691 ZUP-31MB6115-17-NF 10/1/2017 10/1/2017 10/1/2018 10/1/2018 EACH OCCURRENCE $1,000,000 X _ -- — AGGREGATE $1,000,000 DED X 1 RETENTION $0 Excess $5,000,000 A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y /N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? 7 NIA 4177329 10/1/2017 10/112018 x PER OT H- STATUTE ER E.LCH ACCIDENT .E—A- E500,000 E.L. DISEASE - EA EMPLOYEE �- $500,000 (Mandatory in NH) If yyes, describe under DESGRIPTION OF OPERATIONS below "----- E.L. DISEASE - POLICY LIMIT __— _-- $500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) If Yes is indicated above for add1 insd forms Gen Liab #CG7201 07/17, #CG7201 07/17(completed operations), Auto Liab #CA7109 01/17 applies. If Yes is indicated above for waiver of subrogation forms Gen Liab #CG7201 07/17. Auto Liab CA7109 01/17 and WC #WC000313 04/04 applies. Coverage is extended for work performed and required under written contract with the above named insured. If blanket coverage applies, state regulations limit the information that may be added regarding additional insureds to include policy form numbers only. City of Ft. Collins CO is named as additional as per written contract. CERTIFICATE HOLDER CANCELLATION City of Fort Collins PO Box 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. AUTHO 1 ED REPRESENTATIVE 4%e0aµ C 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD