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HomeMy WebLinkAbout353928 CONCRETE STABILIZTION TECHNOLOGIES INC - INSURANCE CERTIFICATEC I ie nt#: 1084369 CONCRSTA ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE (MMlDD/YYYY) 12/20/2017 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER USI Colorado, LLC Construction P.O. Box 7050 Englewood, CO 80155 800 873-8500 NAME, Client Manager PHONE g00 873-8500 FAx E"t : /vc, No : 303-831-5295 E N E-MAIL ADDRESS: den.contractors@usi.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Pal Insurance Company 34118 INSURED Concrete Stabilization Technologies, Inc 8500 E. Warren Avenue Denver, CO 80231 INSURER B : National Union Fire Ins Pittsburgh, PA _ 19445 41190 ac INSURER C : PI"nol Assurance Company INSURERD: WestfleldInsurance Company 24112 INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER: 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 CONTRACTOR 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. LTRINS TYPE OF INSURANCE ADDLSUBR NSR WVD POLICY NUMBER MMIDDY EFF MM/DD YYXYY LIMITS A X1 71 COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR BI/PD Ded:10000 103GLOO2139001 1 /01 /2018 01/01/2019 EACH OCCURRENCE $1 OOO OOO PREMISES ERENTED occur ence $ 5O OOO X GEN'L MED EXP (Any one person) $ N/A PERSONAL & ADV INJURY $1,000,000 AGGREGATE LIMIT APPLIES PER: PRO - POLICY X JECT LOC OTHER: I GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OPAGG $2,000,000 $ D AUTOMOBILE LIABILITY X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED X AUTOS ONLY X AUTOS ONLY TRA5119279 1/01/2018 01/01/201 COMB Ea cciddenter")_NGLELIMIT a 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ $ B UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE EBU012841881 0110112018 01101 /2019 EACH OCCURRENCE s2.000.000 X AGGREGATE s2,000,000 DED RETENTION $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITYIER ANY PROPRIETOR/PARTNER/EXECUTIVE nY / N OFFICER/MEMBEREXCLUDED? lJ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A 4121092 01/01/2018 01/01/201 X PTR T OTH- E.L. EACH ACCIDENT $500OOO E.L. DISEASE - EA EMPLOYEE $500000 E.L. DISEASE -POLICY LIMIT s500,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) As required by written contract or written agreement, the following provisions apply subject to the policy terms, conditions, limitations and exclusions: the City of Fort Collins is included as Additional Insured for work, acts or omissions under the General Liability and Automobile Liability on a primary and non contributory basis and Additional Insured under Automobile Liability but only with respect to liability arising out of the Named Insured's work performed on behalf of the certificate holder. City of Fort Collins Financial Services; Purchasing Division 215 N. Mason Street, 2nd Floor;P.O. 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 ACORD 25 (2016103) 1 of 1 #S22128365/M22119124 ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AHMZP