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Home My WebLink AboutDELTA CONSTRUCTION - INSURANCE CERTIFICATE (3)F CERTIFICATE OF LIABILITY INSURANCE °04/30/2004 04/30/2004 PRODUCER (303)939-9921 FAX (303)939-9926 Herbert -Leavitt Longmont 275 South Main Street Suite 208 Longmont, CO 80501 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC 9 INSURED Delta Construction, Inc 208 Raquette Or Fort Collins, CO 80524 INSURERA: Travelers INSURERB: Pinnacol Assurance INSURERC: Fireman's Fund INSURER D: INSURER E: liel'I a-a•_Ici =K1 THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDINI 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. INSR &DO1 UM TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE iMM/DDIM POLICY EXPIRATIONJ.IEL DATE (NIMMO/M LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE F OCCUR DTC0384P7423INDO4 04/30/2004 04/30/200S EACH OCCURRENCE $ 1' DOD DD DAMAGE TO RENTED $ 300,00( MED EXP (Any one person) $ S,00 PERSONAL & ADV INJURY $ 11DDD, DD GENERAL AGGREGATE $ 2,000,00( GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PRO- JECT LOC PRODUCTS - COMP/OP AGG $ 2,000,00( AUTOMOBILE LIABILITY ANY AUTO OT810384P7423TIL04 04/30/2004 04/30/2005 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X BODILY INJURY (Per person) $ A ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE (Per accident) $ GARAGE LLA131U AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC AUTO ONLY: AGG $ $ A EXCESSNMBRELLA LIABILITY X1 OCCUR CLAIMS MADE DTSMCUP384P7423TIL04 04/30/2004 04/30/200S EACH OCCURRENCE $ 3,000,00 AGGREGATE $ 3,000,000 $ DEDUCTIBLE X RETENTION $ 10, OD WORKERS COMPENSATION AND 3298114 07/01/2004 07/01/200S X WCSTATU- OTH- EEL EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ 5DD , OD B ANY PROPRIETORIPARTNERIEKECUTIVE OFFICER/MEMBER EXCLUDED? Ryes, describe PROVISIONS SPECIAL PROVISIONS below E.L. DISEASE EA EMPLOYE $ 500DO E.L. DISEASE - POLICY LIMIT $ 50D OD C ulFlder's Risk MXI99469OS6 04/30/2004 04/30/2005 $4,000,000 limit $1,000 deductible DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS e: City of Fort Collins -Moss Rock Wall ertificate holder is named as additional insured. City of Fort Collins Attn: James B O'Neill II, CPPO, FNIGP 215 N Mason 2nd F1 Fort Collins, CO 80521 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WALL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Kelly McNair/KDM 7x r/. AGUKU LO (-LUUTAIU) ©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 (2001/08) ACORD�, CERTIFICATE OF LIABILITY INSURANCE oai30/2 0 ) PRODUCER (303)939-9921 FAX (303)939-9926 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Herbert -Leavitt Longmont ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 275 South Main Street I HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Suite 208 Longmont, CO 80501 INSURED Delta Construction, In 208 Raquette Or Fort Collins, CO 80524 Ke1' 7_ d y INSURERS AFFORDING COVERAGE INSURERA: Travelers INSURERS: Pinnacol Assurance INSURER c: Fi reman' s Fund INSURER D: INSURER E: NAIC # THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTW ITHSTANDINI 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. INSR &DWL um TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE IMM/DnIYYI POLICY EXPIRATIONIm DATE IMMMnIM LIMBS GENERAL LIABILITY DTC0384P7423INDO4 04/30/2004 04/30/2005 EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY CLAIMS MADE rX OCCUR DAMAGE TO RENTED $ 300,00( MED EXP (Any one person) $ S,00( PERSONAL & ADV INJURY $ 1,000,00( GENERAL AGGREGATE $ 2,000,00( GENL AGGREGATE LIMIT APPLIES PER: POLICY X JPERCOT LOC PRODUCTS - COMP/OP AGG $ 2,000,00( AUTOMOBILE LIABILITY ANY AUTO DT810384P7423TIL04 04/30/2004 04/30/2005 COMBINED SINGLE LIMIT (Ea accident) $ 11000,00 X BODILY INJURY (Per person) $ A ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE (Par accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC AUTO ONLY: AGG $ $ EXCESSAIMBRELLA LIABILITY X OCCUR CLAIMS MADE OTSMCUP384P7423TIL04 04/30/2004 04/30/2005 EACH OCCURRENCE $ 3,000,000 AGGREGATE $ 3,000,000 A $ RDEDUCTIBLE X RETENTION $ 10, 00 $ WORKERS COMPENSATION AND 3299114 07/01/2004 07/01/2005 X I WC STATU- JOTH- EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ 500,000 B ANY PROPRIETOR/PARTNER/EY,ECUTIVE OFFICER/MEMBER EXCLUDED? Use describe under AL PROVISIONS below SPECI E.L. DISEASE - FA EMPLOYEE $ 500,000 E.L. DISEASE - POLICY LIMIT $ 50O OO C ory R ui der s Risk MXI99469056 04/30/2004 04/30/2005 $4,000,000 limit $1,000 deductible DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS e: Old Town Square Restrooms ertificate holder is named as additional insured. City of Fort Collins c/o Purchasing 215 N Mason 2nd Fl Fort Collins, CO 80521 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 MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Kelly McNair/KOM J MA AL:UKIJ Z5 (ZOUT/USI OACORD 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. ACUKU zs tzoovaaf