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HomeMy WebLinkAboutPOST BUCKLEY SCHUH JERNIGAN PBS J - INSURANCE CERTIFICATE (2)Ar_mac 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 ADD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE 09/30/2004 POLICY EXPIRATION LIMITS GENERAL LIABILITY 90-1S807-03 09/30/2005 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS MADE [X OCCUR DAMAGE TO RENTED $ 1,000,00( MED EXP (Anyone person) $ 25,00( A X Contractual Liab PERSONAL &ADV INJURY $ 1,000,00( GENERAL AGGREGATE $ 2,000,00( GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X jEC X LOC PRODUCTS - COMP/OP AGG $ 2,000,00( AUTOMOBILE LIABILITY ANY AUTO 90-15807-04 90-1S807-05 09/30/2004 09/30/2005 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,00 X X BODILY INJURY (Per person) $ A ALL OWNED AUTOS SCHEDULEDAUTOS HIREDAUTOS NON -OWNED AUTOS X BODILY INJURY (Per accident) $ X Contractual Liab X PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY -EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC AUTO ONLY: AGG $ $ EXCESS/UMBRELLALIABILITY X OCCUR CLAIMS MADE AUC508762100 09/30/2004 09/30/2005 EACH OCCURRENCE $ 25,000,00 AGGREGATE $ 25,000,000 B $ DEDUCTIBLE $ X RETENTION $ 10,00 $ WORKERS COMPENSATION AND 90-15807-01 09/30/2004 09/30/2005 X WC STATU- A EMPLOYERS'LIABILITY ANV PROPRIETOR/ EXCLUDED? OFeICER/MEMBER EXCLUDED? H yes, describePRO under SPECIAL PROVISIONS below 90-15807-02 NO E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,00 �o essional/ P42304 09/30/2004 09/30/2005 $1,000,000 Limits C ollution Liability Ea Claim and Annual Aggregate CLAIMS -MADE FORM 11/11/1961 Retrodate DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT SPECIAL PROVISIONS ef:RFP P-884 Civil Engineering Annual SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Fort Collins, City Of EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL Attn: Purchasing Department 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, 215 N . Mason Street BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 2nd Floor OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. Fort Collins, CO 80S24 AUTHORIZED REPRESENTATIVE AGORD 25 (2001/08) rwA: Cy/Ul[[1-b/U/ ©ACORD CORPORATION 1988 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 25 (2001108)