HomeMy WebLinkAboutPINKARD - INSURANCE CERTIFICATE (8)AC RQw CERTIFICATE OF LIABILITY INSURANCE
DATE/YY)
11/03/04
/04
(.PRODUCER 1-303-534-4567
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
The INA Financial Group, Inc.
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
INA of Colorado, Inc.
1550 17th Street
Suite 600
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Denver, CO 80202
INSURERS AFFORDING COVERAGE
INSURED
Pinkard Construction
INSURER A: National Union Fire Ina. Co. (AIG)
INSURER B: St. Paul Fire & Marine Insurance Company
9195 Nest 6th Avenue
INSURER C: PinI1aCD1 Assurance
INSURER D:
Lakewood, CO 80215
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.
INSR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
(MMIDOrfY)
POLICY EXPIRATION
DATE (MMIDONY)
LIMITS
B
GENERAL LIABILITY
KC08300189
—DATE
11/01/03
12/01/04
EACH OCCURRENCE
$ 1,000,000
FIRE DAMAGE (Any one fire)
$300,000
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE F_x1 OCCUR
M_ED EXP (Any one person)
$ 10,000
PERSONAL &ADV INJURY
$1,000,000
X BI/PD Ded: 10,000
GENERAL AGGREGATE
$ 21000,000
GENT AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
$ 2,000,000
PRO_LOC
POLICY X ArrT
B
AUTOMOBILE
LIABILITY
ANY AUTO
KC08300189
11/01/03
12/01/04
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 -OWNED AUTOS
X
PROPERTY DAMAGE
(Per aciident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
$
AUTO ONLY: AGG
A
EXCESS LIABILITY
X OCCUR D CLAIMS MADE
BE3207186
11/01/03
11/30/04
EACH OCCURRENCE
$ 10, 000, 000
AGGREGATE
$ 10, 000, 000
DEDUCTIBLE
RX
RETENTION $10,000
$
C
WORKERS COMPENSATION AND
EMPLOYERS'LIABILITY
2321400
10/01/04
10/01/05
X WCSTALIMTU- I JOTH-
ER
E.L. EACH ACCIDENT
$ 100,000
E.L. DISEASE - EA EMPLOYE
$ 100,000
E.L. DISEASE -POLICY LIMIT
$ 500,000
OTHER
f
f
$
DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
Certificate Holder is included as Additional Insured on the General Liability Coverage as required by written contract
or agreement. A Waiver of Subrogation in provided in favor of the Certificate Holder on the General Liability Coverage
RE: Work Order# H-WRF. 2004-1 Daft Odor Control.
City of Fort Collins
00 West La Porte Ave.
.0. Box 580
ort Collins, CO 80522
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 DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
AUTHORIZED REPRESENTATIVE
USA
(7/97) SDZN
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G ACORD CORPORATION 199R
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.