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HomeMy WebLinkAboutCLARK CONSTRUCTION - INSURANCE CERTIFICATE (4)ACORD., CERTIFICATE OF LIABILITY INSURANCE YYYY) oDATE zn7r2/27/MIDD oa 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 INSURER A: Travelers Insurance Clark Construction, Inc. INSURERB. Pinnacol Assurance 1530 Boise Avenue Loveland, CO 80538 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 DATEPOLICVMMIDD/YY EFFECTIVE POLICY DATE MMIDD/YY EXPIRATION LIMITS A GENERAL LIABILITY DTCO283P245ATIL 03/01/04 03/01/05 EACH OCCURRENCE $1000000 X COMMERCIAL GENERAL LIABILITY CLAIMS MADE Fil OCCUR DRMMIS T ERENTED nce) $300000 MED EXP (Any one person) $5 000 PERSONAL & ADV INJURY $1000000 X PDDed:1,000 GENERAL AGGREGATE s2000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2 0OO 000 POLICY X jR0 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) $ HIRED AUTOS NON -OWNED AUTOS X PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO S AUTO ONLY: AGG A EXCESS/UMBRELLA LIABILITY DTSMCUP283P245ATIL 03/01/04 03/01/05 EACH OCCURRENCE s3,000,000 X OCCUR CLAIMS MADE AGGREGATE s3,000,000 $ FDEDUCTIBLE $ X RETENTION $ 10000 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE 4000003 04/01103 04101/04 X WC STATU- OTH- EB- E.L. EACH ACCIDENT s500,000 EL. DISEASE - EA EMPLOYEE $500,000 OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $500,000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / 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 LD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL _ n DAYS WRITTEN 'E TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO $HALL IE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR ACORD 25 (2001/08) 1 #S273555/M273552 REPRESENTATIVE © ACORD CORPORATION 1988