HomeMy WebLinkAboutSINNETT BUILDERS - INSURANCE CERTIFICATE (6)ACORM CERTIFICATE OF LIABILITY INSURANCE 07102/04°YY'"'
PRODUCER 8 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
CONFERS NO RIGHTS UPON THE CERTIFICATE
Flood & Peterson Insurance Inc JUL2004 HOLDER.T
HIS CERTIFICATE DOES NOT AMEND, EXTEND OR
4821 Wheaton Drive ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P O Box 270370
Fort Collins, CO 80527 INSURERS AFFORDING COVERAGE NAIC #
INSURED INSURERA: Travelers Insurance
Sinnett Builders, Inc. INSURERB: American International Companies
P.O. Box 1969— INSURERC: Pinnacol Assurance
Fort Collins, CO 80522
INSURER 0:
INSURER E:
Cr1VFRARFS
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
N R
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE MWD /YY
POLICY EXPIRATION
DATE MWDDI
LIMITS
A
GENERAL LIABILITY
DTCO283N62791ND
06/30/04
06/30/05
EACH OCCURRENCE
$1 000 000
X COMMERCIAL GENERAL LIABILITY
DAMAGE TO RENTED
a300 000
CLAIMS MADE O OCCUR
MED EXP (Any one person)
3$ 000
PERSONAL & ADV INJURY
$1 000 000
GENERAL AGGREGATE
s2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS-COMPIOP AGG
$2 000 000
POLICY X PECT LOC
A
AUTOMOBILE
LIABILITY
ANY AUTO
DT810283N6279TIL
06/30/04
06/30/05
COMBINED SINGLE LIMIT
(Ea accident)
$1,000,000
X
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
X
BODILY INJURY
(Per accident)
$
HIREDAUTOS
NON-OWNEDAUTOS
X
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY. EA ACCIDENT
$
OTHER THAN EA ACC
a
rB
ANY AUTO
S
AUTO ONLY: AGG
EXCESSIUMBRELLA LIABILITY
BE2681534
06/30/04
06/30/05
EACH OCCURRENCE
s5,000,000
X OCCUR CLAIMS MADE
AGGREGATE
$5 000 000
$
DEDUCTIBLE
$
X RETENTION $ 10000
C
WORKERS COMPENSATION AND
4045474
07101/04
07101/05
X I WC STATU- I OTH-
TORY LIMITS EEL
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
E.L. EACH ACCIDENT
a500,000
E.L. DISEASE - EA EMPLOYE
$500,000
OFFICER/MEMBER EXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE - POLICY LIMIT
s500,000
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Re: Soft Gold Park
Certificate holder is named as additional insured, but only as respects
liability arising out of work performed by the named insured (Excluding
Workers' Compensation),
City of Fort Collins: Attn:
John Stephen
P. O. Box 580
Fort 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 SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVE
AIiVKU AD (ZUUTIULI) 1 of 2 #M287392 FAB 0 ACORD CORPORATION 1988