HomeMy WebLinkAboutCLARK CONSTRUCTION - INSURANCE CERTIFICATE (3)Cliont#: 21097
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ACORD- CERTIFICATE OF LIABILITY INSURANCE
DATE jMMIDD[YYYY)
4/1/04
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Flood & Peterson Insurance Inc
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
4821 Wheaton Drive
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P O Box 270370
Fort Collins, CO 80527
INSURERS AFFORDING COVERAGE
NAIC #
INSURED
Clark Construction, Inc.
1530 Boise Avenue
Loveland, CO 80538
INSURERA: Travelers Insurance
INSURER B: Pinnacol Assurance
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.
LTR
NSR
TYPE OF INSURANCE
POLICY NUMBER
DATEPOLICYMM/DD/YYE
POLICY
DATE MM/DD/YY)
LIMITS
A
GENERAL LIABILITY
DTCO283P245ATIL
03/01/04
03/01/05
EACH OCCURRENCE
$1000000
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE EJ OCCUR
DAMAAGE TO RENTEDPRE
a300 000
MED EXP (Any one person)...
$5 OOO_
PERSONAL & ADV INJURY
$1 000 000
X PD Ded:1,000
GENERAL AGGREGATE
s2 000 000
GENT AGGREGATE LIMIT APPLIES PER:
PRODUCTS-COMP/OP AGG
$2000000
POLICY X JE T LOC
A
AUTOMOBILE
LIABILITY
ANY AUTO
DT810283P245ATIL04
03/01/04
03/01/05
COMBINED SINGLE LIMIT
(Ea accident)
$1,000,000
X
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
X
BODILY INJURY
(Per accident)
$
HIREDAUTOS
NON -OWNED AUTOS
X
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
$
AUTO ONLY: AGG
A
EXCESSIUMBRELLA LIABILITY
DTSMCUP283P245ATIL
03/01/04
03/01I05
EACH OCCURRENCE
s3 000 000
X OCCUR CLAIMS MADE
AGGREGATE
s3,000,000
$
DEDUCTIBLE
$
X RETENTION $ 10000
B
WORKERS COMPENSATION AND
4000003
04/01/04
04/01/05
X WC STATU- OTH-
T 1
E.L. EACH ACCIDENT
$SO0,000
EMPLOYERS' LIABILITY
ANY PROPRIETORlPARfNER/EXECUTIVE
E.L. DISEASE - EA EMPLOYE
$500,000
OFFICER/MEMBER EXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE - POLICY LIMIT
1 $500,000
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
ATTN: John Stephen FAX: 221-6707 RE: Fossil Creek Park
The City of Fort Collins is named as additional insured.
(Excluding Workers' Compensation).
City of Fort Collins
Purchasing Dept
215 N Mason
Fort Collins, CO 80524
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL In 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
ACORD 25 (2001/08) 1 #S277281/M277279
0 ACORD CORPORATION 1988