HomeMy WebLinkAbout103009 PORTER INDUSTRIES INC - INSURANCE CERTIFICATE (3)APR-30-2007 11:04 From:
To:Ci" of Fort Collins P.1�2
-AGORD CERTIFICATE OF LIABILITY INSURANCE OF 10 014
DATE(MWDOIYYYY)
D^n'rw-4 MA !mn Innr
LBN Insurance Agency
4949 Thompaon Pkwy
Johnstown CO 80534
Phone:970-635-9400 Fax:970-635-9401
Porter Industrigl , Inc.
Attn: Choty1 Ken ick
5202 Granite street
Loveland CO 80537
ONLY AND CONFER$ NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW,
INSURERS AFFORDING COVERAGE NAIL ie
INSURCRA: The Hartford
INSURFRR VinnaCOl Assurance
INS"w" C
THE T'OLICIC6 Or INSURANCE UH I H) HK.QW HAVE BEEN IWUCO TO THE INSURED NAMFO ABOVE rOn mJE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQVIACMCNT. TERM OR CONDI rION OF ANY CONTRACT OR OTHER DOCUMhN I wrrN RESPECT TO WNICI 111118 CERTIFICATF MAY BE ISSUEO OR
MAY PERTAIN, THE INRURANCP AFFORDED BY THE POLICIk G UFSCHIRFD HEREIN IS SUBJECT TO ALL THE 1FHM8, EXCLUDIONg AND CONDITIONN OF 6UCH
POLICIES. AGORCOATE LIMI I S SHOWN MAY NAVF RFPN REDUCED BYPAID CLAIMH
10RLTR HER TYPE OP Inman NUMBER DATE M3VDDIW E W,T M3Np ... URETB ..
GENERAL LIABILITY
CAOH UCOURRENCC
E 1 , 000 000
A
}( COMMFRCIA1C:ENERALLIAMUTY
34UUMTX0464
04/30/07
04/30/08
PPREMISES(Ea occ"renw)
$306,000
— CLAIMS MADE 71 OnCLIR
MFD EXF (Any me parson)
$ 10 , 000
X Blanket Waiver
PERSONAL &ADV INJURY
$ Z 00-0 , 000
X Blanket Add 11 Ins
7 2 000, 000
GENERAI ACCREGA7G
PROUIIC'rS- COMPJQPACO
GENT, ACCRECATE LIMIT APPLICS PER
32,000 000
17 POLICY X jE LOC
11000,000
Emp Hen.
AUTOMOBILE
LIABILITY
COMBINED BINDLE LIMIT
$1 000,000
A
X
ANYAU'I'O
34UUNTX0464
04/30/07
04/30/00
(E"""'JH""O
' '
ALL OWNCO AUTOS
RnD11. V INJURY
6CHEDULED AUTOS
(Per person)
a
A
HIRED AUTOS
){
bUUILV INJURY
is
A
NON-OWN&DAN1'0H
IP"�nx)idmd}
3
A
X
Blanket waiver
_
nROPERTY DAMAGE
3
(Per Acewanl)
OARAOB LIABILITY
AUTO ONLY - EAACCIDFNT
$
OTHER I'NAN EA ACC
ANY AIITO
i
AUTO ONLY. AGG
3
EXCESSIUMBR66LA LIABILITY
FACH OCCURRENCE
3
OCCUR n CLAIMS MADE
i
A00RFCATE
nEnUCTIBLE
3
RETENTION 3
3
WORKERS COMPINSATION AND
X 7 LI TV- ER
8
BMPLOVPAICTABILITy
ANYPROPAICTOR/PARTNr)Fn? Culver
4038253
07/01/06
07/01/07
_
EL EACH ACCIDENT
$ 1 000 000
IJDFM
UFPICERerlbe
E.L. 01SF.AIW-EA EMPLOYEE
$S,000,000
If yns, tl99CDCe unllel
under
WFECIAL PROVISIONS WIm
1, 1 000, 000
G.L DISFASE - POLICY I IMIT
OTHER
DESCRIPTION OP OPERATIONS I LOCATIONS I VEHICLES 1 EXCLU61ONS ADDED BY ENDORSEMENT 1 SPECIAL PROV1610NS
All Operations - All Locations The Certificate Holder is listed as
Additional Insured in regard to the Ceneral Liability.
City of Ft. Collins
Purchasing Dept.
Attn: K3:istlne
215 N. Mason
Fart Collins CO 00524
FTCOLLI SHOULD ANY OP YHE ABOVE DESCRIBED POLICIES BE CANCELLED BEPORE THE EXPIRATION'
DATE THEREOF, T1I9I2SUING 1016URER WILL ENDEAVOR TO MAIL 10 DAYS WR RN
NOTICE TO THE CERTIFICATE HOLDER NAMED YO THE LEPT. BUT PAILURE TO 00 80 SHALL
IMP03E NO OBLIGATION OR UADILITY OP ANY KIND UPON THE INSURER, ITS A0&NT6 OR ,
APR-30-2007 11:04 From:
To:City of Fort Collins P.2'2
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 contact 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.