HomeMy WebLinkAboutWYATT CONSTRUCTION - INSURANCE CERTIFICATE (2)Certificate of Insurance
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON YOU THE CERTIFICATE HOLDER. THIS CERTIFICATE IS
NOT AN INSURANCE POLICY AND DOES NOT AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES LISTED BELOW.
This is to Certify that
WYATT CONSTRUCTION CO INC
3223 ARAPAHOE AVE SUITE 100
BOULDER CO 80303-1086
is, at the issue date of this certificate, insured by the Company under the policy(ies) listed below. The insurance
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Name and
address of
Insured
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Li
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, afforded by the listed policy(iss) is subject to all their terms, exclusions and conditions and
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TYPE OF POLICY
C IFICATE EXP.
CSONTINUOU
POLICY NUMBER
LIMIT OF LIABILITY
❑ EXTENDED
OTERM
TERM
Coverage Afforded Under WC Law of the
Following States:
EMPLOYERS LIABILITY
WORKERS
5-1-05
WC7-59R-097317-114
CO
Bodily Injury By Accident Each
$ 500,000 Accident
COMPENSATION
Bodily Injury By Disease Policy
$ 500,000 Limit .
Bodily Injury By Disease Each
$ 500,000 Person
GENERAL LIABILITY
5-1-05
YY1-59R-097317-024
General Aggregate Limit
$2,000,000
CLAIMS MADE
Products/Completed Operations Limit
$2,000,000
RETRO GATE
Bodily Injury and Property Damage Liability Per
$1,000,000 Occurrence
Personal and Advertising Injury Per Person/Organization
F7 OCCURRENCE
$1,000,000
Other: Fire Legal Liability Other: Medical Payment
$1,000,000 $1,000,000
AUTOMOBILE LIABILITY
5-1-05
AS2-59R-097317-034
$1,000,000 Each Acc-Single Limt-BI&PD Combined
OWNED
Each Person
FTI NON -OWNED
Each Accident or Occurrence
OHIRED
Each Accident or Occurrence
UMBRELLA EXCESS
5-1-05
T1_1-59R-097317-064
$1,000,000
INLAND MARINE
5-1-05
YM2-59R-097317-054
LEASED/RENTED PROPERTY FROM OTHERS
Contractors Equip.)
ER ANY ONE PIECE OF EQUIPMENT
Additional Comments:
CAVERAGE.
SPECIAL NOTICE-OHn: ANY PERSON WHO, WITH INTENT TO DEFRAUD OR KNO`MNG THAT HE IS FACILITATING A FRAUD AOAXISTMI INSURER, SUBMITS AN APPLICATION OR RUES A CUUM CONTAINING A FALSE OR DECEPTIVE STATEMENT IS GUILTY OF INSURANCE FRAUD.
NOTICE OF CANCELLATION: (NOT APPLICABLE UNLESS A NUMBER OF DAYS IS ENTERED BELOW.) BEFORE THE STATED Liberty Mutual
EXPIRATION DATE THE COMPANY WILL NOT CANCEL OR REDUCE THE INSURANCE AFFORDED UNDER THE ABOVE POLICIES UNTIL Insurance Group
AT LEAST
CERTIFICATE
HOLDER
CITY OF FORT COLLINS
PO BOX 580
FT COLLINS CO 80522
• 6L A4,1
AUTHORIZED REPRESENTATIVE
4-23-04 Mishawaka IN
DATE ISSUED
This certificate is executed by LIBERTY MUTUAL INSURANCE GROUP as respects such insurance as is afforded by Those Companies ES 772R