HomeMy WebLinkAboutJ A R CONCRETE LLC - INSURANCE CERTIFICATE�,""1
'����� CERTIFICATE OF LIABILITY INSURANCE 9AT�;,2�202��,
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIOH7S UPON THE CER7IFICATE HOLDER. THIS CERTIFICATE
DOES NOT AFFIRMATIVELY OR NEOATIVELY AMEND, D(TEND OR ALTER THE COYERAOE AFFORDED 8Y THE pOUCIES BELOW. THIS CERTIFICATE OF
INSURANCE DOES NOT CON9TITUTE A CONTRACT BETWEEN THE ISSUIN4 INSURER{S►, AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE
CERTIFICATE HOLDER.
IMPORTANT: IT t!u certfHcate holder is an /IDOITIONAL INSURED, the polcy(ies} must have ADDITIONAL INSURED provisiw�s or be endorsed. If
SUBROpATION IS WAIVED, subject to the terms and ca�ditions af the policy, certain palicies may require an endorsement. A statemeirt on thfs
ce�liHcate dnes not confer ridits to the certHicate haitlx In lieu of such endorsementfsl.
PRODIICEq
FEDERATED I�AUTLIAL INSURANCE COMPANY
HOME OFFICE: P.O. BOX 328
C7�MATONNA, MN 55060
Ik3URE0
J A R CONCRE7E LLC
266 BASHER DR UNIT 2
BERTHOUD, CO 80513-9163
COVERAOES
CERTIFICATE NUMBER: 31
E�MAIL
CLIENT CONTACT
Fn c, No): SO7-446-4664
iNsunen a:FEDERATED MUTUAL INSURANCE COMPANY '13935
385-273-B INSURE0. 8:
INSURER C:
INSUREA D:
INSUREN E:
INSUREq F:
REVISION NUMBER: 3
TNIS IS TD CERTIFY THAT THE POLICIES Of INSURANCE LISTED BELOW HAVE BEEN ISSUED TO TFiE INSURED NAMED ABOVE FOR THE POUCY PER OD INpICATEQ
NOTWVTHSTANDING ANY REQUIREMEN7. iERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT W TH RESP£CT TO WHICH 7HIS CERTIF CATE MAY BE
ISSUED OR MAY PERTAIN. THE INSURl+NCE AFFORDED BY TME PO�ICIE$ OESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS !WD CONDiT�ONS OF
SUCH POLICIES. IIMITS SH04JN MAY HAVE BEEN REDUC£D BY PAID CLAIMS.
� TYPE OF INSURANGE ���� AOUCY NIiMBER Y EFF PO GY XP UM 73
R COMMEqCIAL GENERAL UABIUTY EMN OCCURRENCE i1,OOO,000
CLNMS•MADE ❑X OCCUR AAIPRE 70 EffTEO PREMI4E3 s�QQ�QQO
MED EMP (My one penon) £XCLUbEd
A Y N 9820202 04/OtY1023 04/07/2024 pERSONPI d PDV INJURV fi WO�pOD
6EH L AGGREGATE LIMIT APPLIES PEN; r+ A � �OU OQO
X POLCY �E d O LOC PRODUCT6 6 COMPlOP ACC SZ,QOO,OOO
OTHER:
AVTOMOBILELIABIU7Y COMBINEDSINOLELIMIT g1�000�000
E� aa�Om
�: IWYAUTO BODILY INJURY �Per Penm�
A O'NNEDAUiOSONLY A��ULED N N 9820202 04/01/2023 04/O1/Zd24 gOqLV IMJURY IPa AcciMnO
HIREDAUTOSOWN�Y NON-OWNED ROPER7YDAMIWE
AUT0.S ONLY iLAcslO�I
x Uh�16RELLAlW6 xOCCUR EACHOCCURRENCE qS,UOO,OOO
A EXCESSLIAB CtAiA75�MADE N N 9820203 04l01/2023 04J�11$QZQ AGOREGATE �5,000,000
DED REiEN110V
WORKERS COMPEN9AilON X PER 67ATU7E IOTpfR
AqD EMPLOYERS' LIA9ILITY �
ANY PROPRiETOR�PPATNER7 EXECUTI�E E.L EACH ACCIDENT f500,000
A OFFICERIMEMBER EXCLUDEDi N/A �'i 9g2�244 04/Olii�3 �/Ol/2a24
�M�ntlelory In NH) E l DISEA6E EA EMPLpVEE SSDD�D�4
�r yn. acscr�ne u,eer
UESCRIPTION OF OYERATIONS 6�luw E.L DISEl3E � POLICV L1MIT SSOO,OOO
DESCRIPTION OF OPERATIOI/S ! 40CA710N5 1 VEHICLES S::�ORO t01. AdQi11pW Rem�rkf Schedule, m�y Ev �tbdwd i} mon W�� �� ��nE�
THE CERTIFICA7E HOLOER IS AN ADDITIOHAL INSURm SIJBJECT TO THE COlOITIONS OF TNE ADDITIONAL INSURED - ONNEfiS, LESSEES OR
CONTRACTORS - AUTOMATIC STA7U5 MHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU El�ORSEMENT FaR GfNERAL LIABILITY.
CERTIFICATE HOLDER CANCELLATION
385-273-8 3} 3 SHOULD ANY OF THE ABOVE DESCRI8ED POUClES BE CANCELLED
CITY OF FORT COLLINS ENGINEERING DEP'
PO BOX 580 BEFORE THE EXPIRATION DATE TNEREOF, NOTICE WlLL BE DELIYERED IN
FOR7 COlLINS. CO 80522-0SBD ACCORDANCE 4VITH THE POLICY PRdVI51QNS.
AUTHOf11ZED REPRESENTAT VE � �
O 1988•2015 ACORO CORPORATION. Atl ►I�ts reserved.
ACORD 25 �2018J03) 7he ACORD name and logo xe registered marks ot ACORD