HomeMy WebLinkAboutMEZA CONSTRUCTION - INSURANCE CERTIFICATEACOR . CERTIFICATE OF LIABILITY INSURANCE 1DATE
1/20103°""'
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
IMA of Colorado, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
1550 17th Street, Suite 600 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Denver, CO 80202
303 534-4567 INSURERS AFFORDING COVERAGE
INSURED INSURER A: Travelers Indemnity Co. of Connectic
Maze Construction Company INSURER B: Travelers Indemnity Co. of Illinois
740 S. Bryant INSURER c: Landmark American Ins Co (" )
Denver, CO 80219 INSURER D: Pinnacol Assurance
INSURER E: *American E & S
GES
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.
INSR
LT
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE MM DD
POLICY EXPIRATION
M D Y
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE FxI OCCUR
X PD Ded:5,000
DTC00113B685TCT03
11/16/03
11/16/04
EACH OCCURRENCE
$1 000 000
FIRE DAMAGE (Any one fire)
$300000.
MED EXP (Any one person)
$5 000
PERSONAL &ADV INJURY
$1,000,000
GENERAL AGGREGATE
$2 000 000
GEN'L AGGREGATE LIM ITAPPL IES PER:
POLICY X PRO LOC
PRODUCTS-COMP/OPAGG
$2000000
B
AUTOMOBILE
X
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULEDAUTOS
HIRED AUTOS
NON-OWNEDAUTOS
DT8100113B685TIL03
11/16/03
11/16/04
COMBINED SINGLE LIMIT
(Ea accident)
$1,000,000
BODILY INJURY
(Per person)
$
X
BODILY INJURY
(Per accident)
$
X
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
ANY AUTO
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
AUTO ONLY: AGG
$
$
C
EXCESS LIABILITY
OCCUR �X CLAIMS MADE
RDEDUCTIBLE
X RETENTION $0
LHA210347
11/16/03
11/16/04
EACH OCCURRENCE
$9 000 000
AGGREGATE
$9 00O 000
$
$
D
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
4037599
12I01/03
12/01/04
TH-
X WC STATT I OER
E.L. EACH ACCIDENT
$1,000,000
E.L. DISEASE - EA EMPLOYEE
$1,000,000
E.L. DISEASE - POLICY LIMIT
$1,000,000
OTHER
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
City of Fort Collins
Attn: Purchasing
215 North Mason
Fort Collins, CO 80524
SHOULD ANYOF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TOMAIL30_DAYS WRITTEN
NOTICE TOTHE CERTIFICATE H OLDER NAM ED TOTH E LEFT, BUT FAILURE TO DO SOSHALL
IMPOSE NO OB LIGATION OR LIAB ILITY OF ANY KIND UPON THE INSU RE R,ITS AGENTS OR
REPRESENTATIVE
AGUKU ZO-5IfIVI)l of 2 OM195527 nAL:UT � ^" . """
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may
require an endorsement. A statement on this certificate does not confer rights to the certificate
holder in lieu of such endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
ACORD25S(7/97)2 of 2 #M195527