Loading...
HomeMy WebLinkAboutCLARK ENTERPRISES - INSURANCE CERTIFICATE (3)ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID D DATE (MMlDD YYYY) CLARK-4 01/13/05 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE LBN Insurance Agency, LLC FC HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 1614 Oakridge Drive, Unit A ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Fort Collins CO 80525 Phone:970-229-9304 Fax:970-229-1398 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Mountain States Insurance Grp INSURER B: Clark Enterprises Construction Co. 80 Factory Rd. Eaton CO 80615 INSURER C: INSURER D: INSURER E. COVERAGES 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. 'NbK LTR RVU INSQ TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MMIDDIYY POLICY EXPIRATION DATE MMIDDIYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE a OCCUR CPP0103409 01/13/05 01/13/06 EACH OCCURRENCE $ 1 , 000 , 000 PREMISES (Ea occurence) $100,000 MED EXP (Any one person) $ 10,000 PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: 17 POLICY X PROJECT MLOC PRODUCTS - COMP/OP AGG $2,000,000 A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULEDAUTOS HIRED AUTOS NON -OWNED AUTOS BAP0103409 01/13/05 01/13/06 COMBINED SINGLE LIMIT (Ea accident) $1 ,000,000 X BODILY INJURY (Per person) $ X BODILY INJURY (Per accident) $ X PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: AGG $ $ A EXCESS/UMBRELLALIABILITY X OCCUR 1:1CLAIMSMADE DEDUCTIBLE X RETENTION $ 10, 000 UMB0103409 01/13/05 01/13/06 EACH OCCURRENCE $11000,000 AGGREGATE $1,000,000 $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? I( yes, describe under SPECIAL PROVISIONS below bi TORY LIMITS ER E. L. EACH ACCIDENT $ E. L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ A A OTHER Rented/Leased Equi builders risk CPP0103409 ICPP0103409 01/13/05 01/13/05 01/13/06 01/13/04 150,000 400,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION CITYFTC 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 FAILURE TO DO SO SHALL City of Fort Collins IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 215 North Mason REPRESENTATIVES. AU RQ REPRE P �-n� Fort Collins CO 80525 ACORD 25 (2001108) © ACORD CORPORATION 1988 `ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID D d DATE(MMIDDIYYYY) CLARK-4 01/13/05 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE LBN Insurance Agency, LLC FC HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 1614 Oakridge Drive, Unit A ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Fort Collins CO 80525 Phone:970-229-9304 Fax:970-229-1398 INSURERS AFFORDING COVERAGE NAIL# INSURED INSURERA: Mountain states In9erance Grp INSURER B: Clark Enterprises Construction Co. INSURER C: INSURER D: 80 Factory Rd. Eaton CO B0615 INSURER E: COVERAGES 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 OFINSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MMIDD POLICY EXPIRAT10N DATE MMIDDIYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE O OCCUR CPP0103409 01/13/05 01/13/06 EACH OCCURRENCE $1,000,000 PREMISES (Ea occurence) $100,000 MED EXP (Any one person) $ 10,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PER& LOC PRODUCTS - COMPIOP AGG s2,000,000 A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULEDAUTOS HIRED AUTOS NON-OWNEDAUTOS BAP0103409 01/13/05 01/13/06 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 X BODILY INJURY (Per person) $ X BODILY INJURY (Per accident) $ X PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: AGG $ $ A EXCESS/UMBRELLA LIABILITY X I OCCUR �CLAIMSMADE DEDUCTIBLE X RETENTION $10 000 UMB0103409 01/13/05 01/13/06 EACH OCCURRENCE $1,000,000 AGGREGATE $1,000,000 $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERlEXECUTIVE OFFICERIMEMBER EXCLUDED? Des, describe under SPECIAL PROVISIONS below TORY LIMITS I ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ A A OTHER Rented/Leased Equi builders risk CPP0103409 ICPP0103409 01/13/05 01/13/05 01/13/06 01/13/06 150,000 1 400,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS ALL OPERATIONS/ALL LOCATIONS rCOYIUIr ATC uni noo CANCFI I ATION FORT CO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL CITY OF FORT COLLINS IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 281 N. NORTH COLLEGE REPRESENTATIVES. Au RIZ REPRES C�l /�'//1.' 1 FORT COLLINS CO 80522 ACORD 25 (2001108) v /awlcu wrcrurw I Ian Iwoo