HomeMy WebLinkAboutCONSTRUCTION CONCEPTS - INSURANCE CERTIFICATEACORD CERTIFICATE OF LIABILITY INSURANCE OP ID DATE(MMIDD/YYYY)
CONST-1 03 12 07
PRODUCER _ THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
LEIN Insurance Agency-FC HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
1614 Oakrid a Drive Unit A ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
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Fort Collins CO 80525
Phone:970-229-9304 Fax:970-229-1398
INSURED
Construction Concepts Inc.
Marc & Kim Dewey
14125 Mead Street
Longmont CO 80504
PrN/5:IQAi1FC
INSURERS AFFORDING COVERAGE NAIC #
INSURER A: EMC Insurance Companies
INSURER B: Plnnacol Assurance
INSURER C:
INSURER D: -
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.
INZN
LTR
ROW'
NSR
TYPE OF INSURANCE
POLICY NUMBER
POCY EFFECTIVE
DATE MM/OD/YY
POLICY EXPIRATION
DATE MIIII
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$ 1000000
PREMISES Eaomurence)
$ 100000
A
X COMMERCIAL GENERAL LIABILITY
3XO-95-53
08/24/06
08/24/07
CLAIMS MADE a OCCUR
MED EXP (Any one person)
$ 5000
PERSONAL BADVINJURY
$1000000
X Blanket Addrl Ins
CG7482 12-00
Contractual Llabl
CIS 00 01 10 01
GENERAL AGGREGATE
$ 2000000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
$2000000
17 POLICY X PRD LOC
JECT
A
AUTOMOBILE
LIABILITY
ANY AUTO
3XO-95-53
08/24/06
08/24/07
COMBINED SINGLE LIMIT
(Ea accident)
$ 1000000
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
X
X
BODILY INJURY
(Per accident)
$
HIREDAUTOS
NON -OWNED AUTOS
X
PROPERTY DAMAGE
(Per accident)
$
--
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
-
$
AUTO ONLY: AGG
EXCESSIUMBRELLA LIABILITY
EACH OCCURRENCE
s2,000,000
A
X OCCUR EICLAIMSMADE
3XO-95-53
08/24/06
08/24/07
AGGREGATE
$2,000,000
$
0DEDUCTIBLE
$
X RETENTION $ 10 , 000
B
WORKERS COMPENSATION AND
EMPLOYERS'LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
4031745
07/01/06
07/01/07
X TORV LIMITS X ER
E.L. EACH ACCIDENT
$1000000
E.L. DISEASE - EA EMPLOYEE
$ 1000000
OFFICER/MEMBER EXCLUDED?
If SPesdeowbe under
ECIAL PROVISONS below
E.L. DISEASE -POLICY LIMIT
1 $ 1000000
OTHER
A
Property Section
3XO-95-53
08/24/06
08/24/07
Leased & 200,000
A
Equipment Floats
RC ON LEASED & REN
D
Rented
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS
Re: Bobcat Ridge House Rehabilitation & Primose Art Studio Remodel
CFRTIFICATF Nnl nFR CANCFI 1 ATInM _r / - _ t �x
FTCOLLI
SHOULD ANY OF THE ABOVE DESCRIBE>CANC
FORE THE EXPIRATION
'CIES9E
DATE THEREOF, THE ISSUING INSURER YISNL "DEAVOR TO MA
DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAi�),�*��THE LEFT, BUT F
- TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ArrGs IND Upda INS
AGENT$ OR
City of Ft . Collins
in ��
215 N. Mason Street
REPRESENTATIVES.
AU E REPRE
�/
Ft. Collins, CO 80524
AGORD 25 (2001108) ov. AGUKU GUKF'UKAI IUN 11105
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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.
FIVVRV L��LVY 1/VO) i