HomeMy WebLinkAboutTEMPLE CONSTRUCTION - INSURANCE CERTIFICATEClient#- 599119
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ACO,BQ C_ ERTIFICATE OF
DATE (MM/DD/YY)
LIABILITY INSURANCE
PRODUCER-
__ _ L 03/29/07
THIS CERTIFICATE IS ISSUE AAS A MATTER OF INFORMATION
Van Gilder Insurance Corp.
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
700 Broadway, Suite 1000
1HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Denver, CO 80203
303 837-8500
INSURERS AFFORDING COVERAGE
INSURED
�'. INSURER A. Travelers Indemnity Company (CL)
Temple Construction Company, LLC
INSURER B Pinnacol Assurance
1404 Duff Drive
Fort Collins, CO 80524
INSURER C.
INSURER D.
INSURER E.
COVERAGES
THE POLICIES OF INSURANCE I ISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMLD ABOVE "OR THE POLICY PERIOD INDICATED NOTWII HSTANDING
ANY RECUIRLMENT TCRM OR CONDITION OF ANY CONTRACT
OR OTHER DOCUMENT WITH RESPI_CT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AlI ORDED BY THE POLICIES DESCRIBED
HEREIN IS SUBJECT TO F-LL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGAIL LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS_
INSR TYPE OF INSURANCE POLICY NUMBER
LTR -
POLICY EFFECTIVE IIPOLICY EXPIRATION I,
DATE (MM/DD/YY) I DATE( MIDD/YY) LIMITS
A GENERAL LIABILITY DTC09684A9151ND07
04/01/07 04/01/08 EACHGCCURRFNJF $1000,000
X 3 omrIFtCI . A NFR, [ I VBII IY
FIRE DAMAGE iAl y one Tire, s300,000
CIAIMS MT: T X OCCUR
MED EXP (An3 ont $5,000
I X PDDed:2,500
i
PERSONAL&AUVINULNY $1,000,000
GENERAL AGGREGATE $2,000,000
GFN'L AGGRF GAIF- 1MIAPPI. IFS PER.
PRODUCTS -COMP/OPAGC 32,000,000
I Poucv X - JCLr � Loc
A AUTOMOBILE LIABILITY DT8109684A915TIL07
04/01/07 04/01/08
X ANY AU Ill
COMBINED SINGLE L,MI I
(Fa accldenp - 1,000,000
AI I OWNLD AU I)S
BOUIIY INJURY $
SCI 1 FD U'_ FD A U I OS
Leer person)
X HIRFDALIIOS
X
BODILY INJURY
NON O,'VNFFAT 1 %S
IPer accident)
PROPER IY DAMAGE $
!(Per amdenp
GARAGE LIABILITY
AUIOON-Y Err ACCIDENI $
ANY AU I U
OTHER rHAN FA ACC s
.
-..;... AUTO ONI Y
AGG s
EXCESS LIABILITY
EACH OCCURRENCI_- 5
OCCUR CLAIMS MADE
AGGREGATE $
S
3
RE IFNI1O =
i
B WORKERS COMPENSATION AND 4079866
'04/01/07 04/01/08 X Dill
EMPLOYERS' LIABILITY
- IokSIIMPS
F.I. EACH AOCIDEN1 S500,000
EL.DISEASE EAFMPLOYFF $500,000
F L DISEASE POLICY I FIN s500,000
A OTHER Leased, QT6607385B257TIL07
04/01/07 11 04/01/08 $250,000 Limit
Rented, Borrowed
Subject to $1,000
Equipment
-Deductible
- -
DESCRIPTION OF OPERAI"IONSIU)CATIONSNEHIC LESIEXC LUSIONS ADDED BY ENDORS EM ENTlSP ECIAL PROVISIONS
RE: Sanitary Sewer Project
City of Fort Collins is included as Additional Insured under
General Liability, as required by written contract.
CERTIFICATE HOLDER _ ADD mONAINSURED; INSURER LETTER. CANCELLATION
SHOULD ANYOF TH E ABOVII DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of Fort Collins
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYSWRITTEN
Purchasing Division
NOTICE TOTHE CERTIFICATE HOLDER NAMED TOTHE LEFT, BUT FAILURE TODOSOSHALL
PO Box 580
IMPOSE NO OBLIGATION CR LIABIL11Y OF ANY KIND UPON THE INSURERJTS AGENTS OR
Fort Collins, CO 80522
REPRESENTATIVES
AUTHORIZED REPRESENTATIVE
(�
^��"� <.,_c; I""!7 oT T #M489170 SKL V) ACORD CORPORATION 1988