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HomeMy WebLinkAbout353928 CONCRETE STABILIZATION TECHNOLOGIES - INSURANCE CERTIFICATE (2)Client#: 1084369 CONCRSTA ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/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 NAME: Client Manager PHONE g00 873-8500 FAX 30 AIC No Ext : 'C, No : 3-831-5295 E-MADDRESS: den.contractors@usi.com Englewood, CO 80155 800 873-8500 INSURER(S) AFFORDING COVERAGE NAIC A INSURER A: Peleus insurance Company 34118 INSURED Concrete Stabilization Technologies,lnc 8500 E. Warren Avenue Denver, CO 80231 INSURER B : National Union Fire Ins Pittsburgh, PA 19445 INSURERC: PinnaeolAeeurenuCompany 41190 INSURER D : Westfield Insurance 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. INSR LTR TYPE OF INSURANCE ADDLSUB INSR WVD POLICY NUMBER POLICY EFF MMIDO POLICY EXP YYY MMIDD/Y LIMITS A COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR BI/PD Ded:10000 _ 103GLOO2139001 1/01/2018 01/01/201 EACH OCCURRENCE $1 OOO 000 !( PREMISESOEaoccurrrence _ $50,000 X MED EXP (Any one person) $ N/A PERSONAL & ADV INJURY $1,000,000 GEN1 AGGREGATE LIMIT APPLIES PER: POLICY [X] ECOTI LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMPIOP AGG $2,000,000 $ _ 1,000,000 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 Ea MINE accdDe151NGLELIMIT BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ $ PROPERTY DAMAGE Per accident B X UMBRELLALIAB EXCESS LIAB X OCCUR CLAIMS -MADE EBU012841881 1/01/2018 01/01/2019 EACH OCCURRENCE $2000000 _ s2,000,000 AGGREGATE DED RETENTION $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITYTuTE ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? � (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N /A 4121092 01/01/2018 01/01/2019 X PER OTH- ER E.L. EACH ACCIDENT $500OOO E.L. DISEASE - EA EMPLOYEE -- $5OO OOO 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) As required by written contract or written agreement, the following provisions apply subject to the policy terms, conditions, limitations and exclusions: the Certificate Holder is included as Additional Insured for work, acts or omissions under the General Liability and Automobile Liability but only with respect to liability arising out of the Named Insured's work performed on behalf of the certificate holder. GtKIIFIGAIL HULUtK GANGtLLAIIUN City of Fort Collins PO Box 580 Ft Collins, CO 80522-0000 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 (2016/03) 1 Of 1 #S22128364/M22119124 ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AHMZP