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DocuSlgn Envelope ID:A3839651-094E-48D2-872A-CD6D1A8820BC V II�i1Igr. I VVJLLJ TEMPLCON4 DATE(MM/DD/YYYY) ACORD. CERTIFICATE OF LIABILITY INSURANCE 9/20/2022 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). ONTACT PRODUCER NAME: Shelia Bartlett USI Insurance Services, LLC I(AICNN E :800 873-8500 AX1AC No P.O. Box 7050 EMAIL den.contractors@usi.com Englewood,CO 80155 INSURERS AFFORDING COVERAGE NAIC x 800 873-8500 INSURER A:Charter Oak Fire Insurance Company 25615 INSURED INSURER B:Travelers Property Cas.Co.of America 25674 Temple Construction Company, LLC INSURER c:Pinnacol Assurance Company 41190 1404 Duff Drive INSURER D:Travelers Indemnity Company of CT 25682 Fort Collins,CO 80524 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. LT R TYPE OF INSURANCE DDL UBR POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS LTR A X COMMERCIAL GENERAL LIABILITY X X DTC04E638443COF22 4/01/2022 04/01/2023 EACH OCCURRENCE $1 MUM CLAIMS-MADE u OCCUR AEM,MA ET ERENTED $300 OOO X PD Ded:2,000 MED EXP(Any oneperson) $5 000 PERSONAL&ADV INJURY $1 OOO 000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE s2,000,000 �I PRO POLICY U JECT 0 LOG PRODUCTS-COMP/OP AGG s2,000,000 OTHER $ D AUTOMOBILE LIABILITY X X 8108M81081 A222SG 4/01/2022 04/01/2023 COMBINED SINGLE LIMIT S1,000,000 X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X AHIRED UTOS ONLY X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY (Per accident) X Drive Oth Car $ B X UMBRELLA UAB X OCCUR X X CUP2J350840222S 4/01/2022 04101/2023 EACH OCCURRENCE s5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 DED I X I RETENTION$10,000 C WORKERS COMPENSATION X 4079866 4/01/2022 04/01/202 X PqTATiER OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E L EACH ACCIDENT 1 OOO 000 OFFICER/MEMBER EXCLUDED? pJ N/A (Mandatory in NH) E L DISEASE-EA E $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) CERTIFICATE HOLDER CANCELLATION CDOT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Greeley Traffic ACCORDANCE WITH THE POLICY PROVISIONS. 10601 W. 10th Street Greeley,CO 80634 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S37408398/M35946543 DVPZP