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Client#:51 AMESCONI <br /> ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD1YYYY) <br /> 12/11/2015 <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS <br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br /> BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to <br /> the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the <br /> certificate holder In lieu of such endorsement(s). <br /> PRODUCER C <br /> NgM.T <br /> MN-COMMERCIAL LINES PHONE <br /> aC,No,Ext 612 349-2400 _" <br /> ( ': _ F(�N,1 612 349 2490 <br /> COBB STRECKER DUNPHY&ZIMMERMANN EMAIL <br /> 150 S FIFTH ST STE 2800 ADDRESS: "__ <br /> MINNEAPOLIS,MN 55402 <br /> INSURER(S)AFFORDING COVERAGE NAIC S <br /> —" - <br /> INSURER A:TRAVELERS INDEMNITY OF AMERICA <br /> INSURED INSURERS:TRAVELERS PROPERTY CASUALTY CO/ <br /> Ames Construction Inc - 1 E_N__S" -"---"- - <br /> 2000 Ames Dr INSURER c:NATIONAL UNION FIRE INSURANCE C <br /> Burnsville,MN 55306 INSURERD: <br /> INSURER E: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br /> INDICATED. NOTWITHSTANDING ANY REOUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR 'ADDL SUBR P EFF _. <br /> LTR TYPE OF INSURANCE INSR WVD , _ , POLICY NUMBER (MM OLICY DD�YYY,0 (POLICY E%P <br /> MM/DD+YYYY)I LIMITS <br /> A X_ IAL GENERAL LIABILITY ?VTC2HCO7408B632 5/01/2015 05/01/2016 EACH OCCURRENCE $2 006.666 <br /> MA <br /> M GET r - -." - <br /> _""""""""�CLAIMS-MADE XI OCCUR PREMISES EaEo Tu rental $300 000 <br /> X CONTRACTUAL LIAB"PER MED EXP(Any one person) $5 000 <br /> " <br /> X POLICY FORM AND XCU PERSONAL&ADV INJURY $2,000 OQO <br /> GEN'L AGGREGATE LIMIT APPLIES PER <br /> GENERALAGGREGATE $4,000,000 <br /> PRO <br /> PRODUCTS-COMP/OP AGG `$4 000,000 <br /> _ POLICY "X JECT I X �LOC �.. <br /> OTHER. <br /> AUTOMOBILE LIABILITY <br /> B AUT <br /> VTC2JCAP58346489 5/Q1/2015 05/01/201 r COMBINED SINGLE LIMIT v"""" <br /> lEaaccident) ____ $21000,000 <br /> ALL OWNED SCHEDULED <br /> X ANY AUTO BODILY INJURY(Per person) $ <br /> AUTOS AUTOS BODILY INJURY(Per accident} $ <br /> NON OWNED - --- <br /> X HIRED AUTOS X AUTOS PROPERTY DAMAGE $ <br /> --- Per accidentl <br /> B )( UMBRELLALIAB X OCCUR VTSMJCUPS$346490 5/01/210 05/01/201 EACHOCCURRENCE `$10 000 000 <br /> EXCESS LAB "' -- <br /> CLAIMS MADE rAGGREGATE $10 000,000 _ <br /> DED J X_RETENTION$1 O t)Oo $ <br /> B WORKERS COMPENSATION VTC2JUB6726B789 5/O1/2015 05/O1/2a1 X PER fOTH- <br /> AND EMPLOYERS'LIABILITY ."_ STATUTE— "__.I�g_ <br /> B ANYPROPRIETORfEXCLUDEtEXECUTIVEYEN VTRJUB83648757 5/01/2015105/01/2016EL.EACHACCIDENT $1000000 <br /> OFFICEF4'MEMBER EXCLUDED? N 111 A _ , <br /> (Mandatory In NH) STOP GAP LIABILITY ONLY IN STATES E.L.DISEASE-EA EMPLOYEE $1,000,000 <br /> It yes,describe under - <br /> DESCRIPTION OF OPERATIONS below - _ - __" <br /> C EXCESS LIABILITY BE29157290 5/01/2015'05/01/201 EACH OCC:$25,000,000 <br /> OCCURANCE FORM AGGREGATE:$25,000,000 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached I1 more space Is required) <br /> Weld County Rd 49 Design-Build Subcontract from US 34 to 1.76 Owner Project#B1400202, IHC Job#3097 <br /> Additional Insured only if required by written contract with respect to General Liability,Automobile <br /> Liability and Umbrella/Excess Liability applies on a Primary basis and the Insurance of the Additional <br /> Insured shall be Non-Contributory: Certificate Holder,Project Owner <br /> The following supersedes the cancellation wording:Should any of the above described policies be cancelled <br /> before the expiration date,10 Days written notice will be delivered to the certificate holder. <br /> CERTIFICATE HOLDER CANCELLATION <br /> Interstate Highway SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Construction Inc ACCORDANCE WITH THE POLICY PROVISIONS. <br /> PO Box 4356 <br /> Englewood,CO 80155 AUTHORIZED REPRESENTATIVE <br /> I <br /> 1988- 4 ACORD CORPORATION.All rights reserved. <br /> ACORD 25(2014101) 1 of 1 The ACORD name and logo are registered marks of ACORD <br /> #S761529/M706551 BAM <br />