HomeMy WebLinkAboutDELTA CONSTRUCTION - INSURANCE CERTIFICATE (4)ACORD,. CERTIFICATE OF LIABILITY INSURANCE °ATE5/0(MM°°""""'
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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
INSURED
Delta Construction of Northern
208 Racquette Drive
Fort Collins, CO 80524
UU V r KA%3t:b
INSURERS AFFORDING COVERAGE
INSURER A:
Travelers Insurance
INSURER :
Pinnacol Assurance
INSURERc:
Fireman's Fund Insural
INSURER D:
INSURER E:
Co.
NAIC #
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
INSRE
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE MWDD/YY
POLICY EXPIRATION
DATE MWOD/YY
LIMITS
A
GENERAL LIABILITY
DTC0384P7423IND03
04/30/03
04/30/04
EACH OCCURRENCE
$1000000
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE 51OCCUR
DDAAMIAGE TORENTEDPREoccurrencel
s300 ODO
MED EXP (Any one person)
$5 000
X PD Ded:1,000
PERSONAL & ADV INJURY
$1 000 000
GENERAL AGGREGATE
$2 000 000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
$2 1000,000
POLICY X PRO LOC
JECT
A
AUTOMOBILE
LIABILITY
ANY AUTO
DT810384P74231ND03
04/30/03
04/30/04
COMBINED SINGLE LIMIT
(Ea accident)
$1,000,000
X
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
HIREDAUTOS
NON -OWNED AUTOS
X
BODILY INJURY
(Per accident)
$
X
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
$
AUTO ONLY: AGG
A
EXCESS/UMBRELLA LIABILITY
X1 OCCUR CLAIMS MADE
DTSMCUP384P7423TIL
04/30/03
04/30/04
EACH OCCURRENCE
s3,000.000
AGGREGATE
s3,000,000
$
DEDUCTIBLE
X RETENTION $ 10000
$
B
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
3298114
07/01/03
07/01/04
X WC STATU- OTH-
T 1
E.L. EACH ACCIDENT
$100,000
ANY PROPRIETOR/PARTNER/EXECUTIVE
E.L. DISEASE -EA EMPLOYE
$100,000
OFFICER/MEMBER EXCLUDED?
If yes, describe under
E.L. DISEASE - POLICY LIMIT
$500,000
SPECIAL PROVISIONS below
C
OTHER Builders
MX198469056
04/30/03
04/30/04
$4,000,000 Limit
Risk
$200,000 Temp Location
$1,000 Deductible
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES! EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
Old Town Square Restrooms
Certificate holder is named as additional insured.
City of Fort Collins
c/o Purchasing
215 N. Mason, 2nd Floor,
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 DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR
AUTHORIZED REPRESENTATIVE
^I wmw L, fLVV "01 1 oT Z #5Z7U53U/MZ529U6 PMK 0 ACORD CORPORATION 1988