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Home My WebLink AboutTEMPLE CONSTRUCTION - INSURANCE CERTIFICATE (3)ACORD- CERTIFICATE OF LIABILITY INSURANCE 0DATE (MM/D 4/01/04DNYYY) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Van Gilder Insurance Corp. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 700 Broadway, 1000 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR y ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Denver, CO 80203 303 837-8500 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURERA: Travelers Indemnity Company (CL) Temple Construction Company, LLC INSURERB: Pinnacol Assurance 1404 Duff Drive INSURER c: Hartford Insurance Group Fort Collins, CO 80524 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 DALTEYMM/DDIYYE PDAICY TE MWDD/YY EXPIRATION LIMITS A GENERAL LIABILITY DTC09684A9151ND 04/01/04 04/01/05 EACH OCCURRENCE $1000000 X COMMERCIAL GENERAL LIABILITY CLAIMS MADE LlJ OCCUR DAMAGE TO RENTED occurrence) $300OOO MED EXP (Any one person) $5 000 PERSONAL B ADV INJURY $1 000 OOO GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2000000 POLICY X PRO- JECT WC A AUTOMOBILE LIABILITY ANY AUTO DT8109384A915TIL 04101/04 04/01/05 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 X BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULEDAUTOS X BODILY INJURY (Per accident) $ HIREDAUTOS NON -OWNED AUTOS X PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY: AGG EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ $ DEDUCTIBLE $ RETENTION $ B WORKERS COMPENSATION AND Binder347954 04101/04 04101/05 X T WC STATU- PER EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE E.L. EACH ACCIDENT $500,000 E.L. DISEASE - EA EMPLOYEd $500,000 OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT 1 s500,000 C OTHER Leased/ 34MSTZ6580 04/01/04 04/01/05 $250,000. Limit Rented/Borrowed subject to $1,000 E ui ment deductible DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS RE: Sanitary Sewer Project City of Fort Collins is included as Additional Insured as respects General Liability only if required by written contract. All coverage terms, conditions and exclusions of the policy apply. City of Fort Collins Purchasing Division PO Box 580 Fort Collins, CO 80522 LD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 'A0_ DAYS WRITTEN 'E TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL iE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR w rr�on ne rnnne me. I —I r V� Y 1n�rJJ, VJV REPRESENTATIVE VVV .. we.�en� n��n��wr,�u •nee