Loading...
HomeMy WebLinkAboutMBI CORP - INSURANCE CERTIFICATEDATA.; 02/02/05 TIME: 11:10 AM TO: 221-6701 PAGE: 002-003 ACORQM CERTIFICATE OF LIABILITY INSURANCE oi'1 i00 s) PRODUCER (303)939-9921 FAX (303)939-9926 Herbert -Leavitt Longmont 275 South Main Street Suite 208 Longmont, CO 80501 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED M111 Corporation P. 0. Box 2085 Ft. Collins, CO $0522-2085 INSVRERA. Admiral Insurance Company 248S6 INSURERB Auto Owners 18988 INsuRERa Pinnacol Assurance INSURER D: Owners 32700 INSURER E: CYTVFCA1SF1C 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. INSRWDIL NaRrDATE TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE I=DDM1 POLICY EXPIRATION DATE IMMIDWYn LIMITS GENERAL LIABILITY CA0000272102 01/31/200S 01/31/2006 EACH OCCURRENCE $ 1,000,000 X COMMERGAL GENERAL LIABILITY DAMAGE TO RENTED Fa ncenrenrot $ SO,OO CLAIMS MADE Fxj OCCUR ME EXP (Any one person) $ Exclude A X Per Project Agg Li PERSONAL B ADV INJURY $ GENERAL AGGREGATE $ 2 000,00 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $ 2,000,00( POLICY X PROJECT_ AUTOMOBILE LIABILITY ANY AUTO 4428262400 01/15/2005 01/15/2006 COMBINED SINGLE LIMIT (Ea accident) $ 1 000,00 X BODILY INJURY (Per person) $ B ALL OWNED AUTOS SCHEDULED AUTOS BGDILY INJURY (Per emIde* $ HIREDAUTOS NON -OWNED AUTOS PROPERTY DAMAGE (Per accident) $ GARAGE UABIUTY AUTO ONLY- EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY. AGG $ ANY AUTO $ EXCESSAIMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ S - DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND 2024460 01/01/2005 01/01/2006 WC STATU- DTH- mLL C EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNERfEXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS beluK E.L. EACH ACCIDENT `-` $ 500,00 EL DISEASE - EA EMPLOYEE $ S00,00 EL.DISEASE- POLICY LIMIT $ 500,00 D cieduled Equip Lsd/Rntd Equip 74282624 02/01/200S 02/01/2006 12,S00 Lsd/Rnt ZS,000 Ded 1,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS e: Downtown Streetscapes Phase III Bid No. 5663 City of Fort Collins Administrative Services Purchasing Division P.D. Box 580 Fort Collins, CO 8OS22-0580 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 MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY AUTHORIZED REPRESENTATIVE ACORD 26 (2001108) FAX: (970)Z21-6707 ©ACORD CORPORATION 1988 02/02/05 TIME: 11:10 AM TO: 221-6707 PAGE: 003-003 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. ACORD 26 (2001108)