HomeMy WebLinkAboutSINNETT BUILDERS - INSURANCE CERTIFICATE (7)Client#: 20369
SINBU
ACORM CERTIFICATE OF LIABILITY INSURANCE
DATE (MMID
12131103D/YYYY)
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
Sinnett Builders, Inc.
P.O. Box 1969
Fort Collins, CO 80522
INSURERA: Travelers Insurance
INSURERS: Pinnacol Assurance
INSURER C:
INSURER D:
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.
LTR
NSR
TYPE OF INSURANCE
POLICY NUMBER
DATE (MM DDIYYPOLICY E
POLICY
DATE MM/DD/YY EXPIRATION
LIMITS
A
GENERAL LIABILITY
CO283N62791ND03
06130/03
06/30/04
EACH OCCURRENCE
$1000000
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE O OCCUR
DAMAGE TO RENTED
PREMI n
$300000
MED EXP (Any one Person)
$5 000
PERSONAL &ADV INJURY
S1,000,000
GENERAL AGGREGATE
s2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
s2,000,000
17 POLICY X jECOT El LOC
A
AUTOMOBILE
LIABILITY
ANYAUTO
810283N6279TIL03
06130103
06/30/04
COMBINED SINGLE LIMIT
(Ea accident)
$1,000,000
X
BODILY INJURY
(Per Person)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY
(Per accident)
$
X
HIRED AUTOS
NON -OWNED AUTOS
X
X
PROPERTY DAMAGE
(Per accident)
$
Drive Other Car
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
$
AUTO ONLY: AGG
A
EXCESS/UMBRELLA LIABILITY
CUP283N6279TIL03
06/30/03
06/30/04
EACH OCCURRENCE
$5 000 000
X OCCUR CLAIMS MADE
AGGREGATE
$5 00Q 000
$
$
DEDUCTIBLE
$
X RETENTION $ 1 Q 000
B
WORKERS COMPENSATION AND
4045474
07101/03
07101/04
X I INN0% CTR-
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
E.L. EACH ACCIDENT
$500,000
E.L. DISEASE - EA EMPLOYEE
$500,000
OFFICER/MEMBER EXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE - POLICY LIMIT
$500,000
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES f 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 gyp_ 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
RERRESENTATIVE
ACORD 25 (2001108) 1 of 2 1. #S268421/M252306 FAB 0 ACORD CORPORATION 1988