HomeMy WebLinkAboutTWIN PEAKS - INSURANCE CERTIFICATEt The IMA Financial Group, Inc.
IMA of Colorado, Inc.
1550 17th Street
Suite 600
Denver, CO 80202
City of Fort Collins
PO Box 580
Fort Collins, CO 80522-0580
USA
USA
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aCORQ. CERTIFICATE OF LIABILITY INSURANCE
DATE9/05 /YY)
o6/a9/Os
`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
Twin Peaks Excavating, Inc.
INSURER A: American International Specialty Lines (AIG)
INSURER B: PinnaCol Assurance
1500 Overlook Drive
INSURER C: Travelers Indemnity Co. of Illinois
INSURER D: Travelers Indemnity Company
Lafayette, CO 80026
INSURER E:
iES
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.
ILTR NSR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE (NIMIDDAM
POLICY EXPIRATION
DATE (MMIDMIM
LIMITS
D
GENERAL LIABILITY
DTC07743BO04IND05
07/01/05
07/01/06
EACHOCCURRENCE
$1,000,000
FIRE DAMAGE (Anyone fire)
$300,000
X COMMERCIAL GENERAL LIABILITY
MED EXP (Any one person)
$ 10,000
CLAIMS MADE 7 OCCUR
PERSONAL B ADV INJURY
$ 1,000,000
R BI/PD DED: $10,000
X
OCP
GENERAL AGGREGATE
$ 2,000,000
GENT AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
$2,000,000
PRO LOG
POLICY X JECT
C
AUTOMOBILE
LIABILITY
ANY AUTO
DT8107743BO04TIL05
07/01/05
07/01/06
COMBINED SINGLE LIMIT
(Ea accident)
$11000,000
X
BODILY INJURY
(Per person) )
$
ALL OWNED AUTOS
SCHEDULED AUTOS
X
BODILY INJURY
(Per accident)
$
HIRED AUTOS
NON -OWNED AUTOS
X
PROPERTYDAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
$
AUTO ONLY: AGG
A
EXCESS LIABILITY
X OCCUR D CLAIMS MADE
B99028641
07/01/OS
07/01/06
EACH OCCURRENCE
$2,000,000
AGGREGATE
$ 2,000,000
DEDUCTIBLE
X RETENTION $10,000
$
B
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
4030583
07/01/05
07/01/06
TH-
X YLIMIT WCoER
E.L. EACH ACCIDENT
$ 500,000
E.L. DISEASE - EA EMPLOYEE
$500,000
E.L. DISEASE. POLICY LIMIT
t500,000
OTHER
f
f
f
DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
RE: License. City of Fort Collins is or are included as Additional Insured(s) on the General Liability Policy as
required by written contract or agreement and with respect to work performed by Insured.
ty of Fort Collins
PO Box 580
Fort Collins, CO 80522-0580
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
SDZN
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m ACORN
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(tes) 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.
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