HomeMy WebLinkAbout168787 GOLDEN TRIANGLE CONSTRUCTION INC - INSURANCE CERTIFICATE (15),' Client#: 8885 rnl nTlal
ACORD- CERTIFICATE OF LIABILITY INSURANCE
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PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
HRH of Colorado
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
720 S. Colorado Blvd Ste PH N
P.O. Box 469025
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Denver, CO 80246-9025
INSURERS AFFORDING COVERAGE
NAIC #
INSURED
Golden Triangle Construction, Inc.
700 Weaver Park Rd.
INSURER A: CNA Insurance Companies
31194
INSURERB: Pinnacol Assurance
INSURER C:
Longmont, CO 80501
INSURERD:
INSURER E:
11
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
ADD'
NSR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE MMIDDIYY
POLICY EXPIRATION
DATE MM/DDIYY
LIMITS
A
GENERAL LU4BR.ITY
TCP2022866738
12/31/03
12/31/04
EACH OCCURRENCE
$1,000000
MMERCIAL GENERAL LIABILITY
CLAIMS MADE 51OCCUR
DAMAGE TO RENTED
$SOO OOO
MED EXP (Any one person)
$5,000
PERSONAL 8 ADV INJURY
$1,000,000
rGENW'L
GENERAL AGGREGATE
s2,000,000
GREGATELIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
$2 OOO OOO
ICY X jEa X LOC
A
AUTOMOBILE
LIABILITY
ANY AUTO
Ci2022866741
12/31/03
12/31/04
COMBINED SINGLE LIMIT
(Ea accident)
$1,000,000
X
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
HIREDAUTOS
NON -OWNED AUTOS
X
BODILY INJURY
(Per accident)
$
X
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
$
AUTO ONLY: AGG
A
EXCESSIUMBRELLA LIABILITY
X OCCUR CLAIMS MADE
CUP2022866786
12/31/03
12/31104
EACH OCCURRENCE
$4 000 000
AGGREGATE
$4 00O 000
a
DEDUCTIBLE
X RETENTION $ 10000
$
B
WORKERS COMPENSATION AND
4013024
10/01/03
10/01/04
VI
X STATU- OTH-
EMPLOYERS' LIABILITY
E.L. EACH ACCIDENT
$1,000,000
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
I(yECIAL PROVISIObe NS
SPECIAL PROVISIONS below
E.L. DISEASE - FA EMPLOYE
$1,000,000
E.L. DISEASE - POLICY LIMIT
$1,000,000
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
2003 Gardens on Spring Creek/ Educational Wing Addition
Bid No. 5748
City of Fort Collins, Colorado, Engineer, Engineer's Consultants and any
other persons or entities identified in contract supplementary
(See Attached Descriptions)
City of Fort Collins, Colorado
300 LaPorte Avenue
Fort Collins, CO 80522
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL _-3n DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
—_" _ _ I OT a 11Fm11 VUDLU
C$J 0 ACORD CORPORATION 1988
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.
-- �_--..- , 19 01 a iFM7`JVOLU
DESCRIPTIONS (Continued from Page 1)
conditions are Additional Insureds as respects to General Liability, Auto
Liability and Umbrella Liability only if required by written contract and
coverage applies only as respects ongoing operations performed by Insured
for the Certificate Holder.
All coverage terms, conditions and exclusions of the policy apply.
Cancellation Clause & Materialy Altered amended: will mail 30 days written
notice to the Certificate Holder. 10 days notice will be given for
non-payment of premium.
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