HomeMy WebLinkAboutCORRESPONDENCE - GENERAL CORRESPONDENCE - 2004 INSURANCE CERTIFICATEACORv,. CERTIFICATE OF LIABILITY INSURANCE OP ID L
DATE (MM/DD/W)
LTZ 1
03/25/04
PRODUCER
Brown & Brown Inc - Ft Collins
125 S Howes, 5th Floor
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
P O Box 2226
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Fort Collins CO 80522-2226
Phone:970-482-7747 Fax:970-484-4165
INSURERS AFFORDING COVERAGE
INSURED
INSURER A: UNITED FIRE AND CASUALTY CO
INSURER B: Pinnacol Assurance
Goltz As haltyCompany
3466 E. ounCO 8D53o7ad 20-C
D
INSURER C:
INSURER DLove:
INSURER E:
li VC
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.
ILTR
TYPE OF INSURANCE
POLICY NUMBER
DATE MM/DD/YY
DATE MMIDDIYY
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
A
X1 COMMERCIAL GENERAL LIABILITY
CLAIMS MADE a OCCUR
60075813
02/02/04
02/02/05
FIRE DAMAGE (Any one fire)
$100,000
MED EXP (Any one person)
$ 5,000
PERSONAL B ADV INJURY
$1,000,000
GENERAL AGGREGATE
$2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY PRO- LOC
JECT
PRODUCTS - COMPIOP AGG
s2,000,000
AUTOMOBILE
LIABILITY
A
ANY AUTO
60075813
02/02/04
02/02/05
(EaCOMBINED SINGLE LIMIT
CO aBINEt)
$1,000,000
_
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY
(Per person)
$
X
X
�
1 HIRED AUTOS
NON-OWNED AUTOS
BODILY INJURY
(Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
IH
GARAGE LIABILITY
AUTO ONLY - EAACCIDENT
$NY
AUTO A
OTHER THAN EA ACC
$
AUTO ONLY: AGG
$
EXCESS LIABILITY
A X OCCUR CLAIMS MADE
60075813
02/02/04
02/02/05
EACH OCCURRENCE
$ 1 , 000,000
AGGREGATE
$1,000,000
DEDUCTIBLE
$
X RETENTION $ 10000
$
WORKERS COMPENSATION AND
B EMPLOYERS' LIABILITY
4055471
04/01/04
04/01/05
X WO LIMITS ER
E.L. EACH ACCIDENT
$500000
E.L. DISEASE - EA EMPLOYEE
$ 5 0 0 0 0 0
E. L. DISEASE -POLICY LIMIT $ 5 0 0 0 0 0
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
CITY OF FORT COLLINS
WATER UTILITIES
ATTN: OPAL
PO BOX 580
FORT COLLINS CO 80522-0580
FTCCITY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIOf
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
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES. _ ........
26-S (7r97)
CORPORA