HomeMy WebLinkAboutPIERSON'S CONCRETE CONSTRUCTION CO - INSURANCE CERTIFICATE (8)�P52(�1N12aW2
AC ORU� CERTIFICATE OF LIABILITY INSURANCE
DATE (MMDONYYY)
04/27/2017
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 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 1-303-534-4567
CONTACT
NAME:
PHONE FAX
AIC No):
IRA, Inc. - Colorado Division
E-MAIL
ADDRESS:denaccounttecha@imacorp.com
1705 17th Street
INSURER S AFFORDING COVERAGE
NAIC 0
Suite 100
INSURER A: UNITED SPECIALTY INS CO (R-T Specialty)
12537
Denver, CO 80202
INSURED
INSURER B: BRPLOYERS ROT CAS CO
21415
INSURER CPINNACOL ASSUR
41190
Pierson•s Concrete Construction Co.
INSURER D:
PO BOX 271248
INSURER E :
INSURER F:
Fort Collins, CO 80527
rnvcoecm:c CFDTIFII"ATF MIIIUIRFR• 4972d937 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.
IN SR
LTR
TYPE OF INSURANCE
ADDL
SUER
NUMBER
MMDDY EFF
POLICPOLICY
EXP
MM DD
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
ATNATL1760262
04/10/17
04/10/18
EACH OCCURRENCE
$ 1,000,000
CLAIMS -MADE t - I OCCUR
RNTED
PREM SESI aEoccurrence)
f 50,000
X
MED EXP (Any one person)
$ Excluded
BI/PD Dad: $5, 000
PERSONAL BADVINJURY
f 1,000,000
AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
f 2,000,000
GEML
PRODUCTS - COMP/OPAGG
$ 2,000,000
POLICY JE O PRO 1-1LOC
$
OTHER:
B
AUTOMOBILE LIABILITY
SX4544718
04/10/17
04/10/18
COM.,dnSINGLELIMIT
Ea accident
$1,000,000
BODILY INJURY (Per person)
$
X ANY AUTO
BODILY INJURY (Per accident)
$
ALL OWNED SCHEDULED
AUTOS AUTOS
NON -OWNED
X HIRED AUTOS X AUTOS
Y DAMAGE
PROPERTY
_
s
A
UMBRELLALULB
N
OCCUR
BTN1763825
04/10/17
04/10/18
EACH OCCURRENCE
$ 2,000,000
AGGREGATE
$ 2,000,000
X
EXCESS LIAB
CLAIMS -MADE
DED RETENTIONi
$
C
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETORIPARTNER/EXECUTIVE Y / N
OFFICERIMEMBER EXCLUDED? a
(Mandatory In NH)
N / A
4055614
07/01/16
07/01/17
X STATUTE ER
E.L. EACH ACCIDENT
j 1,000,000
E.L. DISEASE - EA EMPLOYEE
f 1,000,000
E.L. DISEASE - POLICY LIMIT
j 1,000,000
If yes, descnbe under
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached S more apace Is required)
City of Fort Collins: for Pierson?s Concrete Summer BBQ 2017
City of Fort Collins is included as Additional Insured on the General Liability Policy if required by written contract
or agreement and with respect to work performed by Insured subject to the policy terms and conditions.
L;NKI II-IL;AI r- HVLUtK VA17l,CLLM 11Vre
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Fort Collins THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
PO BOX 1190 AUTHORIZED REPRESENTATIVE /
Fort Collins , Co 80522 USA [[[ / / /" 01988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
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