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HomeMy WebLinkAboutSINNETT BUILDERS - INSURANCE CERTIFICATEACORD CERTIFICATE OF LIABILITY INSURANCE OP ID L DATE SINNE-1 06 18 6/18/07 07 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE LBN Insurance Agency 4 848 Thompson Pkwy HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Johnstown CO 80534 Phone:970-635-9400 Fax:970-635-9401 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: EMC Insurance Companies INSURERB: P1nnacol Assurance Sinnett Builders Inc. SB Construction LLC IBP 14 Co PO BOX 1969 Fort Collins CO 80522 N SURER C: INSURER 0'. 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. LTR NSR TYPE OF INSURANCE POLICY NUMBER POLICYE FEC IVE DATE MM/DD/YY POLICY EXPIRATION DATE MM/DDIYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY 3X23769-06 06/30/07 06/30/08 PREMISES (Ea occurence) $300,000 CLAIMS MADE 191 OCCUR MED EXP (Any one person) $ 5,000 PERSONAL BADVINJURY $1,000,000 X Banket AI FORM CG7462 X Blanket Waiver FROXCG7555 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2, 000, 000 POLICY X PRO - LOC A AUTOMOBILE AUTOMOBILE LIABILITY ANY AUTO 3X23769-06 06/30/07 06/30/08 COMBINED SINGLE LIMIT (Ea accident) $ 1, 000,000 X BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS X BODILY INJURY (Peraccident) $ HIRED AUTOS NON -OWNED AUTOS X PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY: AGG EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 5 , 000 , 000 A X OCCUR ❑CLAIMSMADE 3X23769-06 06/30/07 06/30/08 AGGREGATE $5,000,000 $ DEDUCTIBLE $ X RETENTION $ 10 , 000 B WORKERS COMPENSATION AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE 4045474 07/01/07 07/01/08 j{ TORY LIMITS I X I ER E.L. EACH ACCIDENT _ $500, 000 E.L. DISEASE - EA EMPLOYEE $ 500 , 000 OFFICER/MEMBER EXCLUDED? IF yes, describe under SPECIAL PROVISIONS below BU T WAIVER OF SUBROGA E.L. DISEASE - POLICY LIMIT $ 500 , 000 OTHER A Equipment 3X23769-06 06/30/07 06/30/08 Rented or $50,000 A Builders Risk 3X23769-06 06/30/07 06/30/08 Leased $1000 ded DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS All Operations - All Locations. The Certificate Holder is listed as Additional Insured in regard to the General Liability. CERTIFICATE HOLDER CANCELLATION FTCOLLI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL City of Fort Collins IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR P.O. BOX 580 REPRESENTATIVES. Ft. Collins CO 80522 AURIZE REPRES T C ACORD 25 (2001/08) © ACORD CORPORATION 1988 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. 12001/08) ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID L DATE(MM/DDIYYYY) 5INNE-1 06 18 07 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE LBN Insurance Agency HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 4848 Thompson Pkwy ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Johnstown CO 80534 Phone:970-635-9400 Fax:970-635-9401 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A. EMC Insurance Companies INSURERB: Pinnacol Assurance NSURER C: Sinnett Builders Inc. SB Construction LLC IBP 14 Corp PO BOX 1967 Fort Collins CO 80522 INSURER D: 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. LTR ADD'L INSRE TYPE OF INSURANCE POLICY NUMBER POLICY DATE MM DDJYY E PDATEY MMIDD/YY EXPIRATION LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X X COMMERCIAL GENERAL LIABILITY 3X23769-06 06/30/07 06/30/08 PREMISES (Ea oaurence) $300,000 CLAIMS MADE 1XI OCCUR MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $11000,000 X Banket Al FORM CG7462 X Blanket Waiver GENERAL AGGREGATE $2 000,000 FROMCG7555 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $2,000,000 POLICY X PRO LOC JEOT A AUTOMOBILE X LIABILITY ANYAUTO 3X23769-06 06/30/07 06/30/08 COMBINED SINGLE LIMIT (Ea accident) $ 1 000,000 BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS X X BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHERTHAN EA ACC AUTO ONLY: AGG $ ANYAUTO 1 $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE s5,000,000 A X OCCUR �CLAIMSMADE 3X23769-06 06/30/07 06/30/08 AGGREGATE $5,000,000 $ DEDUCTIBLE $ X1 RETENTION $10 , 000 B WORKERS COMPENSATION AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE 4045474 07/01/07 07/01/08 X IMITS XIUIH- TORV LER E.L. EACH ACCIDENT $500 OOO E.L. DISEASE - EA EMPLOYEE $ 500 , OOO OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below SL MT WAIVER OF EUBROGA E.L. DISEASE -POLICY LIMIT $500,000 OTHER A Equipment 3X23769-06 06/30/07 06/30/08 Rented or $50,000 A Builders Risk 3X23769-06 06/30/07 06/30/08 Leased $1000 ded DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Project: General Contractor for Fire Station Expansion; P-872: Fire Station #5 Addition City of Fort Collins and Poudre Fire Authority are named as additional insureds with respects to the general liability. CERTIFICATE HOLDER CANCELLATION CITYFOR SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL City of Fort Collins IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 300 LaPorte Ave. REPRESENTATIVES. Fort Collins CO 80522 AU RDE REPRES �+ G ACORD 25 (2001/08) © ACORD CORPORATION 1988 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. rzoovosi