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Home My WebLink About113294 DRAHOTA DEVELOPMENT CO - INSURANCE CERTIFICATE (5)Client#: 31698 DRACO ACORD- CERTIFICATE OF LIABILITY INSURANCE DNY""' U625U PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Flood & Peterson Insurance Inc 4821 Wheaton Drive 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 270370 Fort Collins, CO 80527 INSURERS AFFORDING COVERAGE NAIC # INSURED Drahota Construction Co. Drahota Development Company LLC P.O. Box 272269 Fort Collins, CO 80527 INSURERA: Canal Indemnity Company INSURERB: EMC Insurance Company INSURERc: Evanston Insurance Company INSURER0: Pinnacol Assurance 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. NS LTR N D' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE M POLICY EXPIRATION DATE MMID LIMITS A GENERAL LIABILITY CGLO19558 12/01/02 12/01/03 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Me occurrence) a100 000 CLAIMS MADE Ex —]OCCUR MED EXP (Any one person) $5 000 PERSONAL & ADV INJURY $1,000,000 X BI Ded:1,000 X PD Ded: 10,000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG s2000000 POLICY X jE7 LOG B AUTOMOBILE LIABILITY ANY AUTO 2E6223703 cT"" i f 12101/02.-'7, AST COMBINED SINGLE LIMIT (Ea accident) $1,000,000 X BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS `'J `) 2� --ORT C 1_� .� X BODILY INJURY (Per accident) $ X ;.,',NAGE- PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AU70 ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: AGG $ ANY AUTO $ IC EXCESSIUMBRELLALIABILITY CUBW1034902 12/18/02 12/01/03 EACH OCCURRENCE $5000000 X OCCUR CLAIMS MADE Excludes AGGREGATE s5,000,000 $ Residential/ $ FDEDUCTIBLE Multi Family $ X RETENTION $ 10000 Construction WORKERS COMPENSATION AND 2286970 07101/03 07101104 TATUD oTH- X WC SLIMITS EEL EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $1 OOO OOO E.L. DISEASE - EA EMPLOYEE $1,000,000 OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT a1,000,000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS RE: Collindale Clubhouse Certificate holder is named as additional Insured, but only as respects liability arising out of ongoing operations performed by the named insured (Excluding Workers' Compensation). City of Fort Collins PO Box 580 Ft Collins , CO 80522 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 ORLIASIUTY OF Y KIND U E INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESEN _ , C // ACORD 25I2001/0R1 4 , Attu-iall'7n MI ID "Q ACORn CORPORATION 12RR ACORD- CERTIFICATE OF LIABILITY INSURANCE °m""' osi25/0 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 INSURERA: Canal Indemnity Company Drahota Construction Co. INSURER B: EMC Insurance Company Drahota Development Company LLC INSURERC: Evanston Insurance Company P.O. Box 272269 INSURER D: Pinnacol Assurance Fort Collins, CO 80527 INSURERE: rnvFRArrR 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 POLICION DATEYMWD /YYE POLICY DATE MMIDD/ LIMITS A GENERALUASIUTY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE Q OCCUR X BI Ded:1,000 CGLO19558 12/01/02 12/01/03 EACH OCCURRENCE $1000000 DAMAGE TO RENTED PREMISES Me occurrence) a100 000 MED EXP (Any one person) $$ 000 PERSONAL & ADV INJURY $1,000,000 X PD Ded: 10,000 GENERAL AGGREGATE s2,000,000 GENT AGGREGATE LIMIT APPLIES PER: POLICY X ECEl LOC PRODUCTS - COMP/OP AGG s2,000,000 B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIREDAUTOS NON -OWNED AUTOS 2E6223703NPL. r ,r„J,,._.,,._ . , ',1 z/0 /d2� >' x� u A �' 2 (� .JF FORT' rK MANAC = /OS ... (� r 1' " " COMBINED SINGLE LIMIT (Ea accident) $1,000,000 X BODILY INJURY (Per person) a X BODILY Per accident)INJURY $ X PROPERTY DAMAGE (Peraccident) $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: AGG $ $ C EXCESSIUMBRELLA LIABILITY X OCCUR CLAIMS MADE FDEDUCTIBLE X RETENTION $10000 CUBW1034902 Excludes Residential/ Multi Family Construction 12/18/02 12/01/03 EACH OCCURRENCE $5000000 AGGREGATE $5 000 000 $ $ $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below 2286970 07/01/03 07/01/04 X WC STATU• OTH- EEL E.L. EACH ACCIDENT a1,000 000 E.L. DISEASE - EA EMPLOYEd $1,000,000 E.L. DISEASE - POLICY LIMIT 1 $1,000,000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS RE: Traffic Operations Facility Certificate holder is named as additional insured, but only as respects liability arising out of ongoing operations performed by the named insured (Excluding Workers' Compensation). City of Fort Collins PO Box 580 Ft Collins , CO 80522 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL An DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO 30 SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KINDJIPON THE INSURER ITS AGENTS OR AUTHORIZED ACORD 25 (2001/081 1 � AM25,117n M.Ip U O ACORD CORPORATION 1988