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HomeMy WebLinkAboutNATIONAL PAVEMENT PARTNERS - INSURANCE CERTIFICATE_�_044i NATIO-3 CIP ID: JY 144CORO' r ATE (MM/DD/YYYY) �� CERTIFICATE OF LIABILITY INSURANCE 08/21/2018 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 CONTANAME: CT Kdren E. Siwek, CPA Brown & Brown Inc 4532 Boardwalk Dr, Suite 200 AC No Ext:970-482-7747 A N,: 970-484-4165 Fort Collins, CO 80525 E-MAIL Karen E. Siwek, CPA ADDRESS: certificates@bbcolorado.com INSURED National Pavement Partners PO Box 272651 Fort Collins, CO 80527 _ INSURER A: Westfield Insurance INSURER B: Pinnacol Assurance INSURER C : INSURER D : INSURER E: INSURER F : r nVFRAnFS CFRTIFICATF NIIMRFR• RFVISION NIIMRFR- 112 190 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 rypE OF INSURANCE ADDL I UBR POLICY NUMBER MM/DD/ POLICYr09/01/2019 LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS -MADE � OCCUR X CWP7893839 09/01/ DAMAGE TO RENTED PREMISES Ea occurrence $ 500,00 MED EXP (Any one person) $ 10,00 PERSONAL & ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 X POLICY JECTPRO- X]LOC PRODUCTS -COMP/OP AGG $ 2,000,00 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,00 BODILY INJURY (Per person) $ A X ANY AUTO X CWP7893839 09/01/2018 09/01/2019 ALL OWNED SCHEDULED AUTOS AUTOS $ BODILY INJURY (Per accident) PROPERTY DAMAGE Per accident NON -OWNED HIRED AUTOS AUTOS $ X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 4,000,00 AGGREGATE $ 4,000,00 A EXCESS CLAIMS -MADE CWP7893839 09/01/2018 09/01/2019 DED TXTRETENTION $ 0 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y❑ 4184436 09/01/2018 09/01/2019 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,00 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N /A E.L. DISEASE - EA EMPLOYEE $ 1,000,00 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT 1 $ 1,000,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is mgWred) City of Fort Collins is included as Additional Insured per policy forms and conditions. CERTIFICATE HOLDE CITYF10 City of Fort Collins 215 N. Mason St. Fort Collins, CO 80521 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 Karen E. Siwek, CPA © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD NATIO-3 PAGE 2 NOTEPAD INSURED'S NAME National Pavement Partners OP ID: JY Date 08/21/2018 If required by written contract, the following forms may apply: General Liability: Blanket Additional Insured - Ongoing Operations CG 2010 Blanket Additional Insured - Completed Operations CG 2037 Blanket Waiver of Subrogation - CG 7137 Per Project Aggregate - CG 2306 General Aggregate - CG 2504A kuto - 3lanket Additional Insured CA 7077 31anket Waiver of Subrogation CA 0444 rella - Following Form corkers Compensation 3lanket Waiver of Subrogation 359-B