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Home My WebLink AboutPINKARD - INSURANCE CERTIFICATEAC"R�„ 10/02/06 CERTIFICATE OF LIABILITY INSURANCE DATE/YY) /O6 PRODUCER 1-303-534-4567 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION The INA Financial Group, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE INA of Colorado, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 1550 17th Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Suite 600 Denver, CO 80202 INSURERS AFFORDING COVERAGE INSURED INSURER A: National Union Fire Ins. Co. of PA (AIG) Pinkard Construction INSURER B:Pinnacol Assurance 9195 West 6th Avenue INSURER Zurich American Insurance Company Lakewood, CO 80215 INSURER D: INSURER E: COVFRArFS. 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE (NIMIDD/YY1 POLICY EXPIRATIONDATE DATE (MM/DOrfY1 LIMBS GENERAL LIABILITY GL0369651201 11/01/05 11/01/06 EACH OCCURRENCE $ 1,000,000 FIRE DAMAGE (An one fire) $ 300,000 X COMMERCIAL GENERAL LIABILITY rC CLAIMS MADE aOCCUR MED EXP (An one person $10,000 PERSONAL$ ADV INJURY $1,000,000 X BI/PD Dad: $50,000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY X PR0- r LOC C AUTOMOBILEuABILITY ANY AUTO BAP369651301 11/01/05 11/01/06 COMBINED SINGLE LIMIT (Ea accident) $ 1, 000, 000 X BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS X BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS X PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY: ASS A EXCESS LIABILITY B87227742 11/01/05 11/01/06 EACH OCCURRENCE $ 1,000,000 X OCCUR CLAIMS MADE AGGREGATE $ 1,000,000 $ DEDUCTIBLE $ X RETENTION $10,000 B WORKERS COMPENSATION AND 2321400 10/01/06 10/01/07 X & STATU- OTH- EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $100,000 E.L. DISEASE - EA EMPLOYE $ 100,000 E.L. DISEASE -POLICY LIMIT $500,000 OTHER s s s DESCRIPTION OF OPERATIONSILOCATIONS VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Certificate Holder is included as Additional Insured on the General Liability Coverage as required by written contract or agreement. A Waiver of Subrogation is provided in favor of the Certificate Holder on the General Liability Coverage and Workers Compensation Coverage as required by written contract or agreement. ty of Fort Collins 281 N. College Ave ?.0. Box 580 Port Collins, CO 80522-0580 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR AUTHORIZED REPRESENTATIVE USA 26-S (71971 latimer 4975732 n IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. zs-s r7r9n ACORQ: CERTIFICATE OF LIABILITY INSURANCE to/o2/o6 DATE CERTIFICATE NY) PRODUCER 1-303-534-4567 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION The INA Financial Group, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE INA of Colorado, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 1550 17th Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Suite 600 Denver, CO 80202 INSURERS AFFORDING COVERAGE INSURED INSURER A: National Union Fire Ins. Co. of PA (AIG) Pinkard Construction INSURER B:Pinnacol Assurance 9195 West 6th Avenue INSURERC:Zurich American Insurance company Lakewood, CO 80215 INSURER D: I INAI IRFR F- COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MMIGOMI POLICY EXPIRATION DATE (NIMIDUffn LIMITS C GENERALLIA191LITY GLO3696SI201 11/01/05 11/01/06 EACH OCCURRENCE $ 1,000,000 FIRE DAMAGE (Any one tire) $ 300,000 X COMMERCIAL GENERAL LIABILITY CLAIMS MADE F-x] OCCUR MED EXP (Any one person) $ 10,000 PERSONAL &ADV INJURY $1,000,000 X SI/PD Ded: $50,000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2, 000, 000 POLICY X PRO- LOD C AUTOMOBILE X LIABILITY ANY AUTO BAP369651301 11/01/OS 11/O1/06 EEaaaBdeent) SINGLE LIMIT $ 1,000,000 BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS X BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS X PROPERTY DAMAGE (Per accident) $ ri GARAGE UASILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY: AGG A EXCESS LIABILITY B87227742 11/01/05 11/01/06 EACH OCCURRENCE $ 10,000,000 X OCCUR CLAIMS MADE AGGREGATE $ 10, 000, 000 $ DEDUCTIBLE $ X RETENTION $10,000 S WORKERS COMPENSATION AND 2321400 10/O1/06 10/O1/07 X WC BTATIT- OTH- EEL EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYE0 $100, 000 E.L. DISEASE - POLICY LIMIT 1 $500, 000 OTHER E E E DESCRIPTION OF OPERATION&LOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS Certificate Holder is included as Additional Insured on the General Liability Coverage as required by written contract or agreement. A Waiver of Subrogation is provided in favor of the Certificate Holder on the General Liability Coverage RE: Work Order# H-WRF. 2004-1 Daft Odor Control. CCQTICI!`a TC "ni niCo I1 .. .,. / AM/ CI 1 ATInM SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of Fort Collins DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SMALL 300 West La Porte Ave. IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR P.O. Sox 580 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Fort Collins, CO 80522 USA AGUMU ZO-b ("tot) iacimer (r1A%;UMU LPUHYUMAIJUN TIWTP 4975617 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ss-9 n/sn ACOM CERTIFICATE DATE2/06MMIDDIM OF LIABILITY INSURANCE 10/0/06 PRODUCER 1-303-534-4567 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION The INA Financial Group, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE INA of Colorado, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 1550 17th Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Suite 600 Denver, Co 80202 INSURERS AFFORDING COVERAGE INSURED Pinkard Construction INSURER A: National Union Fire Ins. CO. Of PA (AIG) INSURER B:Pinnacol Assurance 9195 Nest 6th Avenue INSURER C: Illinois Union Ins Co (ACE American Ina Cc) INSURER D: Zurich American Insurance Company Lakewood, CO 80215 INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY CL0369651201 11/01/05 11/01/06 EACH OCCURRENCE $ 1,000,000 FIRE DAMAGE(An We tire) $300,000 X COMMERCIAL GENERAL LIABILITY rD CLAIMS MADE � OCCUR MED EXP (An one person) $ 10,000 PERSONAL B ADV INJURY $1,000,000 X BI/PD Dad: $50,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY X PRO LOC D AUTOMOBILE LIABILITY ANY AUTO BJLP369651301 11/01/05 11/01/06 COMBINED LIMIT (Ea accident) $1,000,000 g BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS X BODILY INJURY (Per accident) $ HIRED AUTOS NON-OWNEDAUTOS X PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY: AGG A EXCESS LIABILITY B37227742 11/01/05 11/01/06 EACH OCCURRENCE $ 1,000,000 X OCCUR CLAIMS MADE AGGREGATE $ 1,000,000. $ DEDUCTIBLE $ X RETENTION $10,000 B WORKERS COMPENSATION AND 2321400 10/01/06 10/01/07 X I WC STITU-ORY I JITH- EEL EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $100, 000 E.L. DISEASE - EA EMPLOYE $ 100,000 E.L. DISEASE -POLICY LIMIT $ 500, 000 OTHER C Professional Liability CEOG23567519001 11/01/05 11/01/06 Each Claim $ 21000,000 Pollution Liability Aggregate $ 2,000,000 $2,000,000 Shared Lmt with Pollution Ji Each Claim Ded. $ 25,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS City of Fort Collins, Colorado is included as Additional Insured on the General Liability Policy as required by written contract or agreement and with respect to work performed by Insured. CERTIFICATE HOLDER I I AnnlT NAI. INatIRFn. INRORFR I FTTFR- CANCELLATION RE: CONSTRUCTION OF A 49,980 SQ. FT. NORTHSIDE AZTLAN CENTER LOCATED AT 112 EAST WILLOW STREET, FORT COLLINS, CO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of Fort Collins, Colorado DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO $0 SHALL 215 North Nason Street, 2nd Floor IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR PO Box 580 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ,' Fort Collins, CO 80522 USA " ACORD 25S (7197) Latimer O ACORD CORPORATION 19M 4975836 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. 25-S