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HomeMy WebLinkAboutRKL - INSURANCE CERTIFICATEACORDM CERTIFICATE OF LIABILITY INSURANCE oiio3iz o PRODUCER (303) 756-9909 FAX (303) 756-8818 *Kel l er-Lowry Insurance Inc 1777 S Harrison St #700 Denver, CO 80210 Teresa Heupel THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED RKL Construction Corporation 6500 Stapleton Dr SO. D-12 Denver, CO 80216 INSURERA: Bituminous Insurance INSURERS: Pinnacol Assurance INSURER C: INSURER D: INSURER E: c-rivFrzcr.Fc 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 ADD - TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY CLP3171022 08/04/2004 08/04/2005 EACH OCCURRENCE $ 1' 000 OO X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 100,000 A CLAIMS MADE V OCCUR MED EXP (Any one person) $ 5,00( PERSONAL & ADV INJURY $ 1,000,00( GENERAL AGGREGATE $ 2,000,00( GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO- JECT LOC PRODUCTS - COMP/OP AGG $ 2,000,00( AUTOMOBILE LIABILITY ANY AUTO CAP3171023 08/04/2004 08/04/2005 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,00 X BODILY INJURY (Per person) $ A ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSAIMBRELLA LIABILITY X OCCUR ❑ CLAIMS MADE CUP2 5 7202 5 08/04/2004 08/04/2005 EACH OCCURRENCE $ 5 , 000 , OO AGGREGATE $ 5,000,006 A $ DEDUCTIBLE X RETENTION $ 10,00 $ WORKERS COMPENSATION AND 4004154 08/01/2004 08/01/2005 X I WC STATU- I X I OTH- EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ 1,000,000 B ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under E.L. DISEASE - EA EMPLOYEE $ > 1> 000 OO E.L. DISEASE - POLICY LIMIT $ 1,000,00 SPECIAL PROVISIONS below A OTHER Leased & Rented Equipment CLP3171022 08/04/2004 08/04/2005 $25,000 Max Limit Per Item $50,000 Aggregate Limit DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS he City of Fort Collins is additional insured as their interest may appear with regard to general liability. City of Fort Collins Att: Engineering Department P 0 Box S80 Fort Collins, CO 80522-OS60 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 MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INS AUTHORIZED REPRESENTATIVE Sibeli ITS AGENTS OR REPRESENTATIVES. ruu oAt'umu ZO (ZUUT/Uts) ©ACORD CORPORATION 1988 y" , . 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. ACORD 25 (2001108)