HomeMy WebLinkAboutCORRESPONDENCE - GENERAL CORRESPONDENCE - 2004 INSURANCE CERTIFICATEACORDTM CERTIFICATE OF LIABILITY INSURANCE a1`1104 '°°YY"'
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Flood & Peterson Insurance Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
821 Wheaton Drive HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
4
4 2 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Box 270370
Fort Collins, CO 80527 INSURERS AFFORDING COVERAGE NAIC #
INSURED INSURERA: Zurich
Connell Resources, Inc. INSURERB: Pinnacol Assurance
4305 E. Harmony Road
INSURER C:
Fort Collins, CO 80528-9527 INSURER D:
INSURER E:
COVFRAr F.q
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.
INSR
LTR
kD
NSR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE MMIDDIYY
POLICY EXPIRATION
DATE D
LIMITS
A
GENERAL LIABILITY
CP03757824
06/01/03
06/01/04
EACH OCCURRENCE
$1 000 000
X COMMERCIAL GENERAL LIABILITY
DAMAGE TO RENTED
$300 000
CLAIMS MADE FX_1 OCCUR
MED EXP (Any one person)
$10 000
PERSONAL & ADV INJURY
$1 000 000
X PD Ded:250
GENERAL AGGREGATE
s2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS-COMP/OP AGG
s2000000
POLICY JE� LOC
A
AUTOMOBILE
LIABILITY
ANY AUTO
CP03757824
06/01/03
06/01/04
COMBINED SINGLE LIMIT
(Ea accident)
$1,000,000
X
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULEDAUTOS
X
BODILY INJURY
(Per accident)
$
HIRED AU70S
NON -OWNED AUTOS
X
X
PROPERTY DAMAGE
(Per accident)
$
Drive Other Car
rl
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
$
AUTO ONLY: AGG
A
EXCESS/UMBRELLALIABILITY
AUC3757825
06/01/03
06/01/04
EACH OCCURRENCE
$10000000
X OCCUR CLAIMS MADE
AGGREGATE
$10 000 000
$
DEDUCTIBLE
$
X RETENTION $ 10 000
B
WORKERS COMPENSATION AND
4029651
06101/03
06/01104
U- OEH-
X WCSTATIT EEL
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNEWEXECUTIVE
E.L. EACH ACCIDENT
$500,000
E.L. DISEASE - EA EMPLOYJ
$500,000
OFFICER/MEMBER EXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE - POLICY LIMIT
$500,000
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS
RE: Northeast Area Overlay Project - Property at County Road 11
Certificate holder, Owner, Engineer, Engineer's Consultants are named as
additional insured, but only as respects liability arising out of work
performed by the named insured (Excluding Workers' Compensation).
City of Fort Collins
Purchasing Division
PO Box 580
Fort Collins, CO 80522-0580
LD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3Q_ DAYS WRITTEN
:E TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
W NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR
FRFJIIALIVFS
ACORD 25 (2001108) 1 of 2 #S277120/M248960 NIK 0 ACORD CORPORATION 1988