HomeMy WebLinkAboutCNI CONTRACTORS - INSURANCE CERTIFICATE (3)rliun4ii• R797
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ACORM CERTIFICATE OF LIABILITY
INSURANCE
DATE
05/04/05DmYY)
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
HRH of Colorado
720 S. Colorado Blvd Ste 600-N
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P.O. Box 469025
Denver, CO 80246-9025
INSURERS AFFORDING COVERAGE
NAIC #
INSURED
CNI Contractors, Inc.
1207 South Lipan St.
Denver, CO 80223
INSURER A: Mountain States Insurance Grp
5900
INSURER B: Pinnacol Assurance
10780
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.
IN3R
LTR
ADD'
NSR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
(MMIDDIYYI
POLDATE
LIICY EXPIRATION TE (MM/DDfYYI
LIMITS
A
GENERAL LIABILITY
CPP0105277
05/01/05
05/01106
EACH OCCURRENCE
$1000000
DAMAGE TO RENTED
$1 OO OOO
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE O OCCUR
MED EXP (Any me person)
$5 000
PERSONAL& ADV INJURY
$1 OOO 000
X PD Ded:1,000
GENERAL AGGREGATE
$2 000 00O
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
$1 00O 000
17 POLICY F X PRO- LOC
A
AUTOMOBILE LIABILITY
BAP0105277
05/01/05
05/01/06
COMBINED SINGLE LIMIT
X ANY AUTO
(Ee accident)
$1,000,000
BODILY INJURY
$
ALL OWNED AUTOS
SCHEDULED AUTOS
(Per person)
BODILY INJURY
$
X HIRED AUTOS
X NON -OWNED AUTOS
(Per accident)
PROPERTY DAMAGE
$
(Per accident)
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
$
AUTO ONLY: AGG
A
EXCESS/UMBRELLA LIABILITY
UMB0105277
05/01/05
05/01/06
EACH OCCURRENCE
$2 000 000
X1 OCCUR CLAIMS MADE
AGGREGATE
s2,000,000
$
DEDUCTIBLE
$
X RETENTION $ O
B
WORKERS COMPENSATION AND
4002957
07/01/04
07/01/05
X TWORSLINTTATU- O FIR
EMPLOYERS' LIABILITY
E.L. EACH ACCIDENT
$500000
ANY PROPRIETOR/PARTNER/EXECUTIVE
E.L. DISEASE - EA EMPLOYEE
$500000
OFFICER/MEMBER EXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE - POLICY LIMIT
$500000
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS
Re: Contractors License
* The following cancellation conditions always apply:
-10 days for non-payment of premium
(See Attached Descriptions)
City of Ft. Collins
300 LaPorte Avenue
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
REPRESENTATIVE
ACORD 25 (2001/08) 1 of 3 #M250475 TMR o ACORD CORPORATION 1988
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may
require an endorsement. A statement on this certificate does not confer rights to the certificate
holder in lieu of such endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
ACORD 25-S (2001/08) 2 of 3 #M250475
DESCRIPTIONS (Continued from Page 9) 1
- If policy shown, 10 days for Workers' Compensation for fraud;
material misrepresentation; non-payment of premium; other reasons
approved by the Commissioner of Insurance
AMS 25.3 (2001/08) 3 of 3 #M250475