HomeMy WebLinkAboutPINKARD - INSURANCE CERTIFICATE (5)ACORD. CERTIFICATE OF LIABILITY INSURANCE
0DATE
9/1/074/07MY)
PRODUCER 1-303-534-4567
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
INA of Colorado, Inc.
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
1550 17th Street
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Suite 600
Denver, CO 80202 _
INSURERS AFFORDING COVERAGE
INSURED
Pickard Construction
INSURER Zurich American Insurance Company
INSURERS National Union Fire Ins. Cc of PA (AIG)
9195 West 6th Avenue
INSURER Pinnacol Assurance
INSURER
Lakewood, CO 80215
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
INS
TYPE ANCE
POLICY NUMBER
POLICY EFFECTIVE
POLICY EXPIRATION
LIMITS
A
GENERAL LIABILITY
GL0369651202
11/01/06
11/01/07
EACH OCCURRENCE
$ 1,000,000
FIRE DAMAGE (Any one tire)
$ 300,000
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE lxl OCCUR
MED EXP (Any one person)
$ 10,000
PERSONAL& ACV INJURY
$ 1,000,000
X BI/PD Died $50,000
GENERAL AGGREGATE
$ 2,000,000
G 1 AGGREGATE LIMIT APPLIES PER
PRODUCTS COMP/OPAGG
It 2,000,000
POLICY X PRO LOG
A
AUTOMOBILE
X
LIABILITY
ANYAUTO
13AP369651302
11/01/06
11/01/07
COMBINED SINGLE LIMIT
(EA acc�den0
$ 11000,000
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
X
BODILY INJURY
(Per accident)
$
HIRED AUTOS
NON -OWNED AUTOS
X
PROPERTY DAMAGE
(Per accident)
$
GAR AGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANYAUTO
1
$
AUTO ONLY AGO
B
EXCESS LIABILITY
SE7227889
11/01/06
11/01/07
EACH OCCURRENCE
$ 1,000,000
X OCCUR CLAIMS MADE
AGGREGATE
$ 1,000,000
IS
DEDUCTIBLE
$
X RETENTION $10,000
C
WORKERS COMPENSATION AND
2321400
10/01/07
10/01/08
uATtu
X WC STmT sl OTH
EMPLOYERS LIABILITY
E L EACH ACCIDENT
$ 500, 000
E L DISEASE EA EMPLOYEE
$ 500,000
E L DISEASE POLICY LIMIT
$ 500,000
OTHER
E
E
$
DESCRIPTION OF OPERATIONS/LOCATIONSNEFIICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Certificate Holder is included as Additional Insured on the General Liability Coverage if required by written contract
or agreement Subject to the policy terms and conditions A Waiver of Subrogation is provided in favor of the Certificat
Holder on the General Liability Coverage and Workers Compensation Coverage if required by written contract or agreement
subject to the policy terms and conditions
CERTIFICATE HOLDER I I ADDITIONAL INSURED. INSURER LETTER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City
of Fort Collins
DATE THEREOF THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
281 N College Ave
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
P.O.
Box 580
REPRESENTATIVES
AUTHORIZED REPRESENTATIVE ,'i
Fort Collins, CO 80522-0580
USA
" m"
ACORD 25-S (7/97) millshae O ACORD CORPORATION 1988
6997652
by Ia*]:i
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
25-S