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Home My WebLink AboutDOME CORPORATION - INSURANCE CERTIFICATEDATE (MMIDD/YYYY) ACORD CERTIFICATE OF LIABILITY INSURANCE CSR KM I DOMEC-1 08 06 07 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Sauter Insurance Group HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 233 E. Larkin St. P.O. Box 552 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Midland MI 48640 Phone: 989-835-6701 Fax: 989-835-2964 INSURERS AFFORDING COVERAGE NAIC Y INSURED INSURER Harl ayrvilla Lake Statae A -XI INSURERS Accident Fund- AX 10166 Dome Corporation of North America INSURER C HY Corryanaation Nanayara-AX 5450 East Street Saginaw MI 48601 INSURER Great American Ina - A XIV INSURER Zurich No. America 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 u NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MMIDDYY POLICY EXPIRATION DATE MMAD LIMITS GENERAL LIABILITY I EACH OCCURRENCE $1000000 A X COMMERCIAL GENERAL LIABILITY MP/GL2-3-7J6747 09/01/07 09/01/08 PREMISES (E-.) $ 1000 00 t J CLAIMS MADE I X_j OCCUR EXP (Anoneon) per -- $5000 AsyDepr BNRv rPERSONAL _ $1000000 X Explosion, Co11p MP/GL2-3-7J6747 09/01/07 09/01/08 Undergd ERA LAGGREX $ 2000000 GENE AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPIOP AGG s2000000 PRO POLICY X PRO LOC Em Ben. 1000000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1000000 A X ANY AUTO HA1-2-3-4-7J6747 09/01/07 09/01/08 (Ea accidenp _ X ALL OWNEDAUTOS BODILY INJURY $ X SCHEDULEDAUTOS (Per person) BODILY INJURY 5 X HIREDAUTOS X NON-OWNEDAUTOS (Per accident) X Hired Physical BA17J6747 09/01/07 09/01/08 PROPERTY DAMAGE _ (Per accident) $ GARAGE LIABILITY AUTOONLY-EAACCIDENT 5 OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY AGG EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $10000000. D X6 OCCUR ❑ CLAIMSMADE SBU5075992 09/01/07 09/01/08 AGGREGATE $ 10_000000. E S HDEDUCTIBLE $ X RETENTION $10000. WORKERS COMPENSATION AND X TORYLIMITS ER B EMPLOYERS' LIABILITY WCV5020472 09/01/07 09/01/08 ELCH ACCIDENT 1000000 ANY PROPRIETORIPARTNERIFXECIJTPIE _EA _$ C OFFICERJMEMDEREXCLUDED'I W521504-NY 09/01/07 09/01/08 EL DISEASEEAEMPLOYEE $ 1000000 If yes, describe under SPEC IAL PROVISIONS below El DISEASE -POLICY LIMIT $1000000 OTHER A Leased Equip MP2-3-7J6747 09/01/07 09/01/08 Leased Eq 153000 ea E Bldrs Risk BR64572250 07/19/07 07/19/08 Inst/Bldr 979560 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS City of Fort Collins, CO is named as Additional Insured. The Contractor agrees to indemnify and save harmless the City, its officers, agents 6 employees. CERTIFICATE HOLDER CANCELLATION FORTC-1 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 215 N. Mason IMPOSE NO OBLIGATION OR LABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Fort Collins CO 80524 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Kurt O. Ieuter ACORD 25 (2001108) C ACORD CORPORATION 1988