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HomeMy WebLinkAboutNIXCAVATING INC - INSURANCE CERTIFICATE (7)ACORD® �� CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY) 12/15/2016 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 endorsement(s). PRODUCER Ewing -Leavitt Insurance Agency, Inc. 4090 Clydesdale Parkway Suite 101 Loveland CO 80538 CONTACT Karole Peters NAME: A�NN Ex : (970) 679-7355 aAiXc No: (866)237-2178 ADDREss:karole-peters@leavitt.com INSURERS AFFORDING COVERAGE NAIC # INSURERA:Cincinnati Insurance Co 10677 _ INSURED Nixcavating, Inc. P. O. BOX 2232 Longmont CO 80501 INSURER B :Pinnacol Assurance 41190 INSURER C: INSURERD: INSURER E INSURER F COVERAGES CERTIFICATE NUMBER:17-18 WC 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 INSURANCE ADDL UBR POLICY NUMBER EFF MMLIDYNYYY LIDY EXP MM LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR Blkt Additional Insured EPP0124847 10/1/2016 10/1/2017 EACH OCCURRENCE $ 1,000,000 DAMAGE To PREMISES (E. occur RENTED )$ 500,000 X MED EXP (Any one person) $ 10,000 X Blkt Waiver of Sub PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY [X]PE� LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ A AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED X HIRED AUTOS X AUTOS X Blkt Al X Blkt WOS EPP0124847 10/l/2016 10/1/2017 COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ $ BODILY INJURY (Per accident) PROPERTY DAMAGE Per accident $ $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE EPP0124847 10/1/2016 10/1/2017 EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 DED I X I RETENTION $ 0 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/ PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A 2113100 Blanket Waiver of Subrogation Included 1/1/2017 1/1/2018 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000 000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 A Lease or Rented Equipment EPP0124847 10/1/2016 10/1/2017 Limit with $500 Deductible $220,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Fort Collins is additional insured on the general liability policy as regards work performed by the insured. l;tK I IVIGA l It HULUtK UAN(;tLLA I IUN 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. AUTHORIZED REPRESENTATIVE Karole Peters/KAPETE VA<40--� ACORD 25 (2014101) 1 NS025 (201401) ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD