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�QBQTM CERTIFICATE OF LIABILITY
INSURANCE
osn9/o9°m
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
IMA of Colorado, Inc.
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
1550 17th Street, Suite 600
Denver, CO 80202
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
303 534-4567
INSURERS AFFORDING COVERAGE
INSURED
Hydro Construction Company, Inc.
301 East Lincoln Avenue
Fort Collins, CO 80524
INSURERA: Zurich American Insurance Company
INSURER B: National Union Fire Ins. Co. (AIG)
INSURER C: Pinnacol Assurance
INSURER D:
INSURER E:
1
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.
NSR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE IMMIDDIYYI
POLICY EXPIRATION
DATE (MMIDDIM
09130/05
LIMBS
A
GENERAL LIABILITY
CP0343758100
09/30/04
EACH OCCURRENCE
$1 000 000
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE Fx] OCCUR
FIRE DAMAGE (Any one fire)
$300,000
MED EXP (Any one person)
$1 O 000
PERSONAL & ADV INJURY
$1,000,000
X PD Ded:5,000
GENERAL AGGREGATE
s2,000,000
GEN'L AGGREGATE LIM ITAPPLIES PER:
PRODUCTS -COMPIOPAGG
s2000000
POLICY X IROjECT X LOC
A
AUTOMOBILE
LIABILITY
ANY AUTO
CP0343758100
09/30/04
09/30/05
COMBINED SINGLE LIMIT
(Ea accident)
$1,000,000
X
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
X
X
HIRED AUTOS
NON -OWNED AUTOS
BODILY INJURY
(Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
$
AUTO ONLY: AGG
B
EXCESS LIABILITY
X OCCUR CLAIMS MADE
BE2911514
09/30/04
09/30/05
EACH OCCURRENCE
$1,000,000
AGGREGATE
$1,000,000
$
a
DEDUCTIBLE
Is
X RETENTION $10000
C
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
2091550
04/01/05
04/01/06
X WC QR STATIT OTH-
'EEL
E.L. EACH ACCIDENT
$100,000
E.L. DISEASE - EA EMPL OYEE
$100,000
E.L. DISEASE -POLICY LIMIT
s5OO OOO
OTHER
DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
RE: 2004-Poudre Pipeline Bellvue Valves.
City of Fort Collins is included as Additional Insured on the General Liability Policy as required by written contract or
agreement and with respect to work performed by Insured.
City of Fort Collins
300 W. LaPorte Ave.
Fort Collins, CO 80522
SHOULD ANYOF THE ABOVE D ESCRISED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30—DAYSWRITTEN
NOTICE TOTHE CERTIFICATE HOLDER NAMED TOTH E LEFT, BUT FAILURE TO DO BOSH ALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURE R,RS AGENTS OR
REPRESENTATIVE
^- -•• —^�• 1 01 c SIV124/OTU AJP1 0 ACORD CORPORATION 1988