HomeMy WebLinkAboutCORRESPONDENCE - GENERAL CORRESPONDENCE - INSURANCEDATE (MMIDDIYY)
ACORD. CERTIFICATE OF LIABILITY INSURANCE 1o/ol/2005 1 11/29/2004
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Lockton Companies ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
8110 E Union Avenue HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
Suite 700 ALTER THE COVERAGEAFFORDED BY T E PO I IE BELOW,
Denver CO 80237 INSURERS AFFORDING COVERAGE
(303)414-6000
INSURED INSURER A: St. Paul Companies
1047338 9885 Emporia Street Construction, Inc. INSURER B: Pinnacol Assurance
Henderson, CO 80640 INSURER C
'.T/ [ITT
%.UVr=r%AOCJ DI<. INV1 vv
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
TR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE I NUDDNYi
POLICY EXPIRATION
DATE (MMIDDIYYI
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE Fx-1 OCCUR
KC08300263
10/03/2004
10/03/2005
EACH OCCURRENCE
$ 1,000,000
FIRE DAMAGE (Any one fire
$ 300,000
MED EXP (Any oneperson)
$ 5,000
PERSONAL & ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2,000,000
GENIL AGGREGATE LIMIT APPLIES
POLICY X JECT X
PER:
LOC
PRODUCTS - COMP/OP AGG
$ 2,000,000
A
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIREDAUTOS
NON-OWNEDAUTOS
KC08300263
10/03/2004
10/03/2005
COMBINED SINGLE LIMIT
(Ea accident)
$ 1,000,000
X
BODILY INJURY
(Per person)
$ XXXXXXX
X
BODILY INJURY
(Per accident)
$ XXXXXXx
X
PROPERTY DAMAGE
(Per accident)
$ XXXXXJIX
GARAGE LIABILITY
ANY AUTO
NOT APPLICABLE
AUTO ONLY - FA ACCIDENT
$ XXXXXXX
OTHER THAN EA ACC
AUTO ONLY: AGG
$ XXXXXXX
$ XXXXXXX
A
EXCESS LIABILITY
X OCCUR CLAIMS MADE
UMBRELLA
El
DEDUCTIBLE FORM
RETENTION $
KC08300263
10/03/2004
10/03/2005
EACH OCCURRENCE
$ 1,000,000
AGGREGATE
$ 1,000,000
XXXYIXXX
${X,
$ xxxxXxX
B
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
4023016
10/01/2004
10/01/2005
X WC TATU- OTH-
E.L. EACH ACCIDENT
$ 100,000
E.L. DISEASE - FA EMPLOYEE
$ 100,000
E.L. DISEASE - POLICY LIMIT
1 $ 500,000
OTHER
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
RE: City of Fort Collins Contract No. P951. City of Fort Collins is included as Additional Insured as respects General Liability.
I
2146488
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
Attn: Purchasing
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL
215 North Mason St.
Ft. Collins, CO 80524
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
ACORD 25-S (7/97) Fwquestions nBardlnethis cartlRcae,aMxdthe number head Inthe TwduaYsecaonaboveand specaythe client ade'BTCON01'. ®ACORD CORPORAIION 1988