HomeMy WebLinkAboutGT ALLIANCE - INSURANCE CERTIFICATEACORD.
CERTIFICATE OF
LIABILITY INSURANCE
DATE(MWODNYYY)
06/11/2004
PRODUCER (970) 484-2805
John C. Beckett &Associates, Inc.
220 Smith Street
Ft. Collins CO 80524-
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
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
NAIC #
INSURED
GT ALLIANCE,
749 S. LEMAY,
FORT COLLINS
INC.
A3, PNB 403
CO 80524—
INSURER A: NORTHERN INSURANCE CO OF
INSURER B: Pinnacol Insurance
INSURERC:United States Liability
INSURER D:
INSURER E:
ww�,r•e w n cc
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
ADWL
IN RD
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE MWDD
POLICY EXPIRATION
DATE MWDD
LIMITS
A
GENERAL LIABILITY
/ /
/ /
EACH OCCURRENCE
$ 1,000,000
PREMISE(Ea oarence
$ 1,000,000
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE OCCUR
PPS041906687
03/01/2004
03/01/2005
MEDEXP (Any oneperson)
$ 10,000
PERSONAL A ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS-COMP/OP AGG
$ 2,000,000
POLICY X JECT LOC
AUTOMOBILE
LIABILITY
ANY AUTO
NO COVERAGE
/ /
/ /
COMBINED SINGLE LIMIT
(Ea accident)
$
BODILY INJURY
(Per person)
It
ALL OWNED AUTOS
SCHEDULED AUTOS
/ /
/ /
BODILY INJURY
(Par accident)
$
HIRED AUTOS
NON -OWNED AUTOS
/ /
/ /
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EAACC
$
ANY AUTO
NO COVERAGE
/ /
/ /
$
AUTO ONLY: AGO
EXCESSIUMBRELLA LIABILITY
NO COVERAGE
/ /
/ /
EACH OCCURRENCE
$
OCCUR CLAIMS MADE
AGGREGATE
$
$
DEDUCTIBLE
$
RETENTION $
$
WORKERS COMPENSATION AND
4076986
01/11/2004
01/01/2005
C g u
TORY LIAMITS OER
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
E.L. EACH ACCIDENT
B
E.L. DISEASE - FA EMPLOYEE
$
OFFICERIMEMBER EXCLUDED?
/ /
/ /
If yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE - POLICY LIMIT
$
C
OTHER Errors & Ommisions
TK1000256A
02/07/2004
02/07/2005
Aggregate 2000000
Each Claim 1000000
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
CFQTIFICATF Nn1 nFR CANCELLATION
( ) -
(970) 224-6134
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
CITY
OF FT COLLINS
PURCHASING DEPT .
FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
281 N. COLLEGE
INSURER, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
P.O. BOX 580
FORT
COLLINS
CO 80524-
1a
ACORD 25 (2001108) ® AUUKU cUKrUKA I IUn THGO
fk..�- INS025 (0108).05 ELECTRONIC LASER FORMS, INC. - (800)327-0545 Page 1 of 2
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).
7FTOX_ll11,14 ;a
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.
ACORD 25 (2001108)
ft,M INS025 piw)m Page 2 of 2