HomeMy WebLinkAboutBOULDER DESIGN - INSURANCE CERTIFICATEACORD. CERTIFICATE OF LIABILITY INSURANCE
DATE
11-06-2003 �
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
VAN GILDER INSURANCE CORP/PHS ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
341438 P: (866)467-8730 F: (877) 905-0457 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P. 0. BOX 33015
SAN ANTONIO TX 78265 INSURERS AFFORDING COVERAGE
INSURED INSURERA:Hartford Casualty Ins Co
BOULDER DESIGN ALLIANCE MR. ROB INSURER B:
DEKIEFFER INSURER C:
3002 MELISSA LN INSURER D:
BOULDER CO 80301 INSURERE:
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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.
INSR'' rypE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICV EXPIRATION
LTR DATE MM/DOM/ DATE MM/DDIYY LIMITS
GENERAL LIABILITY
EACH OCCURRENCE $1 , 0 0 0, 0 0 0
A
COMMERCIAL GENERAL LIABILITY 34 SBA LJ6557
01/01/04
01/01/05 FIRE DAMAGE (Any one fire) $300, 000
CLAIMS MADE LC1 OCCUR
MED EXP (Any one person) $10 , 000
X Business Liab
PERSONAL & ADV INJURY $1, 000, 000
GENERAL AGGREGATE s2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG s2,000,000
POLICY X PRO- JECT LOC
AUTOMOBILE
COMBINED SINGLE LIMIT
$1, 0 0 0, 0 0 0
A
ANYAUTOLIABILITY
34 SBA LJ6557
01/01/04
(Ea accident)
01/01/05
ALL OWNED AUTOS
BODILY INJURY
SCHEDULED AUTOS
(Per person)
$
HIRED AUTOS
BODILY INJURY
X
X
NON -OWNED AUTOS
(Per accident)
$
$
PROPERTY DAMAGE
(Per accident)
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
$
ANY AUTO
�I OTHER THAN EA ACC
AUTO ONLY: AGG
$
EXCESS LIABILITY
EACH OCCURRENCE $
OCCUR a CLAIMS MADE
AGGREGATE $
$
DEDUCTIBLE
$
RETENTION $
$
WORKERS COMPENSATION AND
TWC STATU- OTH-
OF,Y LIMITS R
EMPLOYERS' LIABILITY
E.L. EACH ACCIDENT $
E.L. DISEASE - EA EMPLOYEE $
E.L. DISEASE - POLICY LIMIT
$
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Those usual to the Insured's Operations.
CERTIFICATE HOLDER ADDITIONAL INSURED: INSURER LETTER: CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
45 DAYS WRITTEN NOTICE 110 DAYS FOR NON-PAYMENT) TO THE CERTIFICATE
City of Fort Collins
HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO
256 W Mountain Ave
OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
Fort Collins, CO 80521
AUTHORIZED REPRESENTrAWE
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^""^" 11"1 m ACORD CORPORATION 1988