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HomeMy WebLinkAbout113294 DRAHOTA DEVELOPMENT CO - INSURANCE CERTIFICATE (2)ACORM CERTIFICATE OF LIABILITY INSURANCE 12/01/2005 o6ii/20 s' PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Lockton Companies ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 8110 E Union Avenue HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Suite 700 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Denver CO 80237 INSURERS AFFORDING COVERAGE (303)414-6000 INSURED INSURER A: Canal ln&lli Co. 1051805 Drahota Construction Co. Drahota Development Company LLC INSURER B: Zurich American Insurance PO Box 272269 INSURERC: Pinnacol Assurance Fort Collins, CO 80527 INSURER D :— rweenr_oc nD ArnA1 ArIT 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 LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MMIDDIYY POLICY EXPIRATION DATE MMIDD/YY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE FX7 OCCUR CGL020559 12/01/2004 12/01/2005 EACH OCCURRENCE s 1,000,000 FIRE DAMAGE (Any one fire $ 100000 MED EXP (Any oneperson) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ECT F7 LOC PRODUCTS - COMP/OP AGG $ 2,000,000 B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS CP0375796401 12/01/2004 12/01/2005 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X BODILY INJURY (Per person) $ �'XXXXXX X BODILY INJURY (Per accident) $ XXXXXXX X PROPERTY DAMAGE (Per accident) s XXXY,= GARAGE LIABILITY ANYAUTO NOT APPLICABLE AUTO ONLY - EA ACCIDENT $ XXXXXXX OTHERTHAN EA ACC AUTO ONLY: AGG $ XXXXXXX $ XXXXXXX EXCESS LIABILITY OCCUR CLAIMS MADE UMBRELLA DEDUCTIBLE FORM RETENTION $ NOT APPLICABLE EACH OCCURRENCE $ XXXXXXX AGGREGATE $ XXXXXXX s XXXXXXX s XXXXXXX s XXXXXXX C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY 2286970 07/0I/2005 07/01/2006 }{ WC STATU- OTH- E.L. EACH ACCIDENT s 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 OTHER DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS RE: Collindale Clubhouse. Certificate Holder is named as Additional Insured, but only as respects liability arising out of ongoing operations performed by the Named Insured (excluding Workers Compensation). L`FQTIPICATF unt r1FD I X I annlnn ilal IaICi IQFn• IYCIIPPP I FTTFR- CAlli I ATInN 1912232 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 PO Box 580 Fort Collins, CO 80522 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 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ��JJ'''��'/'� U "tw � c6&-t,_ I ACORD 25-S (7/97) For questions regarding this certificate, contact the number listed In the Producer section above and specify the client code-DRAC001'. © ACORD CORPORATIO 1988