HomeMy WebLinkAboutENVIRONMENTAL ABATEMENT - INSURANCE CERTIFICATE (6)03/01/2005 TUE 9:54 FAX
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AMR-D. CERTIFICATE OF LIABILITY INSURANCE CSR DC
ENVIRI3
DATE(MMIDDTYYY)
1 03 01 05
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Six 6 Geving Insurance, Inc.
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
3630 Sinton Road, Suite 200
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Colorado Springs CO 80907-5034
Phone:719-590-9990 Fax:719-590-9992
INSURERS AFFORDING COVERAGE
NAIC9
INSURED
EAYlr02!)IleAtal Abat�ment
Southwest Inc.; FFalcon
Service, Ing.; 5615
Industrial Place, LLC
P.O. Box 752�2
Colorado Springs CO 80970
INSURERA' Arch Specialty Ins CO
wsuRERa Allied Insurance Group42579
rHsuRERc: Pinnacol Assurance
INSURER O:
INSURER E
COVERAGES
THE POUCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REOUIREAENT, 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
NSRC
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE eff=M
DATE MIO
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
s2,0001000
A
X COMMERCULGENERALLIABIUTY
CLAW MADE ®OCCUR
12EM943438-00
11/27/04
11/27/05
PREMISESEaaarence
$50 000
NED EXP WW one Pomm)
$5 000
PERSONAL &ADYINJURY
$2 000 000
X INCL POLLUTION/
ASBESTOS
GENERAL AGGREGATE
$ 2 000 000
BERL AGGREGATEppORRAST APPLIES PER
PRODUCTS-COMPIOPAGG
$2 00O 000
X POLICY XOT LOC
B
AUTOMOBILE
X
LIABILITY
ANY AUTO
ACP7540805635
02/02/05
02/02/06
(ExE031NGIELIMIT
am
(Ea acdderd)
$1,000,000
BODILY INJURY
(PW Person)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
BOOBY INJURY
(per a=id-1)
$
HIRED AUTOS
NON-OWNEDAUTOS
PROPERTY DAMAGE
(Per aeddent)
$
GARAGE LIABILITY
AUTO ONLY -FA ACCIDENT
$
OTHERTHAN PAACC
AUTO ONLY: AGG
$
ANY AUTO
$
EXCESSNMBRELLALIABLRY
EACH OCCURRENCE
$
OCCUR CLAIMS MADE
AGGREGATE
$
$
$
DEDUCTIBLE
$
RETENTION $
C
WORKERS COMPENSATION AND
EMPLOYERS•LIABLITY
ANY PROPRIETOWPARTNER(EXECUTIVE
OFFICER/MEMBER EXCLUDED?
Oyyeess desalbeunder
SPECIAL PROVISIONS below
4028665
04/01/04
04/01/05
X I TORY I.SuffIS I I R
E.L.EACH ACCIDENT
$1 000 000
E.L. DISEASE• FA EMPLOY
$1,000 000
E.L. DISEASE • POLICY UMIT
$ 1 000 000
OTHER
B
Inland Marine
ACP7540805635
02/02/05
02/02/06
Contr EqP $57,815
B
Pro -RC/S ec Form
ACP7540805635
02/02/05
02/02/06
Bldg $550,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Proof of Insurance. fax: 970:222-6707. Project: Bid #5896 Asbestos
Abatement at Gateway Park. Cart holder is named Liability Additional
Insured
A 4t, : ' TO A.n S '
CERTIFICATE HOLDER CANCELLATION
FORTC-1
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WALL ENDEAVOR TO MAIL 10 DAYS WAHIIEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
City of Fort Collins
215 N Mason St, 2nd Floor
IMPOSE NO OBLIGATION OR LIABILITY OF ANY IOND UPON THE INSURER, ITS AGENTS OR
Ft. Collins Co 80522-0580
REPRESENTATNES.
AUTHORIZED REPRESENTATIVE
Wa a Six
ACORD 25 (2001108) (000, W7re""` ' RD-eCORPORATION 1988