HomeMy WebLinkAboutAMERICAN PORTABLE BUILDINGS - INSURANCE CERTIFICATEACORD CERTIFICATE OF LIABILITY INSURANCE OP ID B DATE(MM/DD/YYYYI
AMERI-8 H1 01 09 04
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
CRS Insurance Brokerage HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
6600 E . Hampden Ave., 2nd Flr. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Denver CO 80224
Phone: 303-996-7800 Fax: 303-757-7719 INSURERS AFFORDING COVERAGE NAIC #
INSURED INSURER A: Mountain Statue Insurance Co.
American Portable Buildings INSURERS: Pinnacol Assurance
Corporation
Corporation INSURER C:
2892 W 64th Avenue INSURER D:
Denver CO 80221
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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.
LTR
NSR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE EFFECTIVE
POLICY EXPIRATION
DATE EXPIRATI'
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
A
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE X� OCCUR
CPP0082490
06/01/03
06/01/04
PREMISES EaoccureDnce)
$ 100,000
MED EXP (Any one person)
$ 10,000
PERSONAL & ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
s2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
$ 2 , 000 , 00 0
POLICY P CO
JECT LOC
A
AUTOMOBILE
LIABILITY
ANY AUTO
BAP0082490
06/01/03
06/01/04
COMBINED SINGLE LIMIT
(Ea accident)
$ 1 , 000 , 000
X
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY
(Per accident)
$
HIRED AUTOS
NON -OWNED AUTOS
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
$
AUTO ONLY: AGG
EXCESSIUMBRELLA LIABILITY
EACH OCCURRENCE
$ 1,000,000
A
X I OCCUR �CLAIMSMADE
UMB0082490
06/01/03
06/01/04
AGGREGATE
$1,000,000
$
0DEDUCTIBLE
$
X RETENTION $10 000
B
WORKERS COMPENSATION AND
EMPLOYERS'LIABILITY
ANY PROPRIETOWPARTNER/EXECUTIVE
OFFICERIMEMBER EXCLUDED?
4071058
07/01/03
07/01/04
I TORY LIMITS I ER
E.L. EACH ACCIDENT
$ 100000
E.L. DISEASE - EA EMPLOYEE
$ 100000
If yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE -POLICY LIMIT 1
$500000
OTHER
A
Commercial Applica
CPP0082490
06/01/03
06/01/04
A
Propertv Section
CPP0082490
06/01/03
06/01/04
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Regarding project: Purchase of surplus equipment for a modular office.
CITYFTC
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
The City of Fort Collins
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
Purchasing Division
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
Attn: Ed Bonnette
P.O. BOX 580
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
Ft. Collins CO 80522
REPRESENTATIVES.
AIIItiORIZED REPR ENT/)FjVE
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