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Home My WebLink AboutD J FOUNDATIONS - INSURANCE CERTIFICATEACM,. OF LIABILITY INSURANCE OP ID F DATE(MMIDD/YYYY) D&JFO-1 08 18 04 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Brown & Brown Insurance HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 825 Delaware Ave . , Suite P102 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Longmont CO 80501 Phone:303-776-3421 Fax:303-776-3219 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: WEST AMERICAN INSURANCE CO 44393 INSURER B: Pinnacol Assurance D & J Foundations, Inc. INSURERC: Admiral Insurance Company P.O. BOX 308 INSURER D: Broomfield CO 80038-0308 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. INS LT"R NSR TYPE OF INSURANCE POLICY NUMBER POLI Y EFFECTIVEPOLICY DATE MM/DDIYY EXPIRATION DATE MMIDDIYY LIMITS (] GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE l X . OCCUR CA00000845-01 l 08/18/04 08/18/05 EACH OCCURRENCE $ 1,000,000 PREMISES(Ea occurence) $50,000 MED EXP (Any one person) $ Excluded PERSONAL&AD,/ INJURY $1,000,000 GENERALAGGREGATE $ 5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- LOC JECT PRODUCTS - COMP/OP AGG $ 1,000,000 B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS BAW52741884 04/01/04 04/01/0S COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: AGG $ $ EXCESSIUMBRELLA LIABILITY OCCUR F-ICLAIMS MADE DEDUCTIBLE RETENTION $ EACH OCCURRENCE $ AGGREGATE $ $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTiVE OFFICERIMEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below 4000953 04/01/04 04/01/05 WC TORY LIMITS ER E.L. EACH ACCDENT 100000 E.L. DISEASE - EA EMPLOYEE $ 100000 E.L. DISEASE -POLICY LIMIT 1 $ 500000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Fax 970 266-0339 CERTIFICATE HOLDER CANCELLATION City of Fort Collins Building & Zoning Dept Brian P.O. Box 580 Fort Collins CO 80522 FORTCOLI 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 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPO HE INSURER, ITS �AGE OR REPRESENTATIVES. . _ I, 1 ernan gs Mnnimm 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. .. Vnu zo {zuu iruo)