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Home My WebLink AboutPINKARD - INSURANCE CERTIFICATE (9)CERTIFICATE OF INSURANCE DATE e1IDD/YY) LIABILITY 0/04ACOR-„ 10/04/04 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. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 1550 17th Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Suite 600 Denver, Co 80202 INSURERS AFFORDING COVERAGE INSURED Piakard Construction INSURER A: National Union Fire Ins. Co. (AIG) INSURERB:St. Paul Fire & Marine Insurance Company 9195 West 6th Avenue INSURER C: Pianacol 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 DATE iumnMM) POLICY EXPIRATION-LM DATE IMMtDDrfY) LIfA1T3 B GENERAL LIABILITY KC08300189 11/01/03 11/01/04 EACHOCCURRENCE $ 1,000,000 FIRE DAMAGE (Any one fire) $300,000 X COMMERCIAL GENERAL LIABILITY CLAIMS MADE F-xl OCCUR MED EXP(Any one person) $ 10,000 PERSONAL &ADV INJURY $ 1,000,000 X BI/PD Ded: 10,000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY X PRO LOG B AUTOMOBILE X LIABILITY ANY AUTO KC08300189 11/01/03 11/01/04 COMBINED SINGLE LIMIT (Ea amdent) $ 1, 000, 000 BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS X BODILY INJURY (Per accident) $ HIREDAUTOS NON -OWNED AUTOS X PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHERTHAN EA ACC $ ANY AUTO $ AUTO ONLY: AGG A EXCESS LIABILITY BE3207186 11/01/03 11/01/04 EACH OCCURRENCE $ 10,000,000 X OCCUR CLAIMS MADE AGGREGATE $ 10, 000, 000 $ DEDUCTIBLE $ X RETENTION $10,000 C WORKERS COMPENSATION AND 2321400 10/01/04 10/01/05 TH- X WCSLIMT OEEL RY EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ 100 , 000 E.L. DISEASE - EA EMPLOYEd $ 100, 000 E.L. DISEASE -POLICY LIMIT 1 $500,000 OTHER f f f DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Certificate Holder is included as Additional Insured on the General Liability Coverage as required by written contract or agreement. A Waiver of Subrogation is provided in favor of the Certificate Holder on the General Liability Coverage RE-. Work Order# H-WRF. 2004-1 Daft Odor Control. CERTIFICATE HOLDER I I AnnimnNA1 INRURFn• iNcuRFR I F R- CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of Fort Collins 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 300 West La Porte Ave. IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR P.O. Box 580 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Fort Collins, CO 80522 USA ACORD 25-S (7/97) jpitre O ACORD CORPORATION 1988 2147132 Powered ByCertificafesNown" 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. nisn rnant i•'JmRr. Dlklvf`nNl C�RD. CERTIFICATE OF LIABILITY INSURANCE "' ,�4 oro,(/04 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: St. Paul Fire & Marine Insurance Co. Pinkard Construction Co. 9195 West 6th Avenue INSURER B: National Union Fire Ins. Co. (AIG) INSURER C: Pinnacol Assurance Lakewood, CO 80215 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. INSR TYPE OF INSURANCE POLICY NUMBER POLITYEFFECTIYE PODLIC EXPIRATE DATION LIMITS A GENERAL LIABILITY X DOM MERCIAL GENERAL LIABILITY CLAIMS MADE [i] OCCUR X BUPD Ded:10000 KC08300189 11/01/03 11/01/04 EACH OCCURRENCE $1000000 FIRE DAMAGE (Any one fire) $300000 MED EXP (Any one person) $10 000 PERSONAL & ADV INJURY $1 000 000 GENERAL AGGREGATE $2 000 000 GEN'L AGGREGATE LIM ITAPPLIES PER: POLICY X PRO- LOC PRODUCTS -COMPIOPAGG $2000000 A AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNEDAUTOS KC08300189 11/01/03 11/01/04 COMBINED SINGLE LIMIT (Es accident) $1 rDDDr000 BODILY INJURY (Per person) $ X BODILY INJURY (Per accident) $ X PROPERTYDAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: AGG $ $ B EXCESS LIABILITY X OCCUR CLAIMS MADE FDEDUCTIBLE X RETENTION $10000 BE3207186 11/01/03 11/01104 EACH OCCURRENCE $10 000 000 AGGREGATE $10 000 000 $ $ ti WORKERS COMPENSATION AND EMPLOYERS' LIABILITY 2321400 10/01/04 10/01/05 TH- X WC STA7U- I OEEL E.L. EACH ACCIDENT $100 000 E.L. DISEASE - EA EMPLOYEE $100,000 E.L. DISEASE - POLICY LIMIT $500 000 OTHER DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLEWEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS RE: Work Order# H-WRF. 2004-1 Daft Odor Control. City of Fort Collins Attn: P.O. Box 580 300 West La Porte Ave. Fort Collins, CO 80522 SHOULD ANYOFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30—DAYSWRITTEN NOTICE TOTHE CERTIFICATE HOLDER NAMED TOTHE LEFT, BUTFAILURE TODOSOSHALL IMPOSE NOOBLIGATION OR LIABILITY OF ANY KIND UPON TH E INSURERJTS AGENTS OR ACORD 25-S (7/97)1 of 2 #M230049 DLM01 0 AUUKL UUKFUKAIPUN TBlru 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. AGORL)Z5St7197f2 Of 2 #M230049