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HomeMy WebLinkAboutLUND-ROSS CONSTRUCTORS INC - INSURANCE CERTIFICATE (4)�® A J�I l`r.v(�R CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY 12/30/2016 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 endorsements . PRODUCER The Harry A. Koch Co. P.O. Box 45279 Omaha NE 68145-0279 CONTACT NAME: P"°NE 402-861-7000 FAX E-MAIL AnnRrqQ- INSURER(S)AFFORDING COVERAGE NAIC # INSURERA:The Cincinnati Insurance CO 10677 INSURED INSURERB:The Cincinnati Indemnity CO 23280 INSURER C : Lund -Ross Constructors, Inc. 4601 F Street P.O. Box 3688 INSURER D Omaha NE 68103 INSURER E : INSURER F : cnvt=aera=c r1=67TIF:r1TF 2E8885504 REVISION NIIMRER- 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 INSURANCE ADDLSUBK INSD WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYVY LIMITS A x COMMERCIAL GENERAL LIABILITY � CLAIMS -MADE l ^ OCCUR CPPOS16276 1/1/2017 1/1/2018 EACH OCCURRENCE $1,000,000 DAMAGE T RENTED PREMISES Ea occurrence $500,000 MED EXP (Any one person) $10,000 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY a JE 0 LOC i OTHER: GENERAL AGGREGATE $2,000,000 PRODUCTS -COMP/OP AGG $2,000,000 $ A AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED SCHEDULED %� HIRED AUTOS X NON -OWNED AUTOS CPA0816276 1/1/2017 1/1/2018 COMBINED SINUIFTnMr— Ea accident $1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMA Per accident $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE CPP0816276 1/1/2017 1/1/2018 EACH OCCURRENCE $10,000,000 AGGREGATE $10,000,000 DIED I I RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) if yes, describe undar DESCRIPTION OF OPERATIONS below N / A WC186461802 1/1/2017 1/1/2018 X STATUTE ER E.L. EACH ACCIDENT $500,000 E.L. DISEASE - EA EMPLOYEE $500,000 E.L. DISEASE - POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) rFRTIFIrATF I-Inl nr-P CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Fort Collins PO BOX 580 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Fort Collins CO 80522-0580 AUTHORIZED REPRESENTATIVE © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD