HomeMy WebLinkAboutGT ALLIANCE - INSURANCE CERTIFICATE (2)ACORD,,,,
CERTIFICATE OF
LIABILITY INSURANCE
DATE11/2004
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:
INSURERE:
C(
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
ADDT
INSFID
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE MMIDD
POLICY EXPIRATION
DATE MM/DD/YY
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMSMADE 7X OCCUR
PPSO41906687
/ /
03/01/2004
/ /
03/01/2005
EACH OCCURRENCE
$ 1,000,000
DAMAGE TO RENTED
PREMISES Ea occurrence
6 1,000,000
MED EXP (Any one on
$ 10,000
PERSONAL& ADV INJURY
$ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY FXJ JEC 7 LOC
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS-COMP/OP AGG
It 2,000,000
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
NO COVERAGE
/ /
/ /
/ /
/ /
/ /
/ /
COMBINED SINGLE LIMIT
(Ea accident)
$
BODILY INJURY
(Per person)
$
BODILY INJURY
(Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
ANY AUTO
NO COVERAGE
/ /
/ /
AUTO ONLY -EA ACCIDENT
$
OTHER THAN EA ACC
AUTO ONLY: AGG
$
It
EXCESSIUMBRELLA LIABILITY
OCCUR CLAIMS MADE
DEDUCTIBLE
RETENTION $
NO COVERAGE
/ /
/ /
/ /
/ /
EACH OCCURRENCE
$
AGGREGATE
$
It
$
$
B
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
It yes, describe under
SPECIAL PROVISIONS below
4076986
01/11/2004
01/01/2005
g U
TORY TAT
ER
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYEE
$
E.L. DISEASE - POLICY LIMIT
8
C
OTHER Errors & Ommisions
TK1000256A
02/07/2004
02/07/2005
Aggzagate 2000000
Each Claim 1000000
DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
CITY OF FT COLLINS
281 N. COLLEGE
P.O. BOX 580
FORT COLLINS
ACORD 25 (2001108)
(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
PURCHASING DEPT . FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
AUTHORIZED REPRESENTATIVE � /
80524- �""`""' C
QzaliL
a ACORD CORPORATION 1
tl, ; INS025 (olos).os
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).
DISCLAIMER
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.
A{yGUKU Z5 (ZUU7/US)
* INS0251oioaym Page 2of2