HomeMy WebLinkAboutSINNETT BUILDERS - INSURANCE CERTIFICATE (11)10- 5-05; 9;57AM;LBN Insurance
;970 229 1398 #P 1/ 2
AICORD. CERTIFICATE OF LIABILITY INSURANCE csR zM DATE(MM/OP/YYYY7
sINNE-1 10 05 05
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
LBN Insurance Agency-FC HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
1614 Oakridge Drive, 13nit A ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Fort Collins CO 80525
Phone: 970-229-9304 Fax: 970-229-1398 INSURERS AFFORDING COVERAGE NAIC #
R(SUREO INSURER A: ZMC Insurance Companies
INSURER 8: Rinnacol Assurance
Sinnett Builders Inc. INSURER C: —
PO Sox 1969 INSURER 0:
Fort Collins CO 80522
INSURER E:
:OVERAGES
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 SHOYJN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR
TYPE OF INSURANCE
POLICY NUMBER
DA MWO
DAT2 MM/OD
LIMTS
GENERAL LIABILITY
EACH OCCURRENCE
$1,000,000
A
X
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE U OCCUR
3X23769-06
06/30/05
06/30/06
PREMISES nee
$300 000
MEO EXP (Any one Weon)
S5,000
PERSONAL&ADVINJURY
Banket AT
FORM CG7462
$1,000,000
_
GENERAL AGGREGATE
s2,000,000
PRODUCTS - COMP/OP AGG
S 2 ,.000., 000
_
GERI, AGGREGATE LIMIT APPLIES PER:
X POLICY JECT El LOC
A
ADTQMDB2E
U&INUTY
ANY AUTO
3X23769-06
06/30/05
06/30/06
COMBINED SINGLE L)Mrr
(Eeaxtew)
31,000,000
X
BCOILY INJURY
(Por Parson)
-_----
i
ALL OWNED AUTOS
SCHEDULED AUTOS
X
BODILY INJURY
(Persodeent)
;
HIREDAUTOS
NON -OWNED AUTOS
X
PROPERTY DAMAGE
(Per accident)
S
GARAGE UAIKITY
AUTO ONLY - EA ACCIDENT
S
OTHER THAN EA ACC
AUTO ONLY: AGG
S
ANYAUTO
$
m(CESSAIMBRELLA LIABRTTY
EACH OCCURRENCE
$5,000,000
A
X OCCUR 7 CLAIMSMADE
3X23769-06
06/30/05
06/30/06
AGGREGATE
$ 5, 000, 000
t
S
HDEDUCTIBLE
S
X RETENTION S10000
B
YJORKERS COMPENSATION AND
ANPLOYMM PR"ITORILRY
ANY pROPR1ETORlPARTNERA:XECUTIVI:
OFFICERIMEMSER EXCLUDED?
der
VXee.AL PROVISIONS below PROIbe SIO
BECIAL
4045474
07/01/05
07/01/06
X YORV LIMITS X ER
EL, EACH ACCIDENT
$500,000 i
EL. DISEASE - EA EMPLOYEE
E.L. DISEASE - POLICY LIMIT
S5OO,000
S500 000
A
OTHER
Equipment
3X23769-06
06/30/05
06/30/06
Rented or $500000
Leased $1000 dad
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / B)(OWBIONS ADDED BY ENDORSEMENTI SPECIAL PROVISIONS
Project: General Contractor for Fire Station Expansion; P-872:
Fire Station #5 Addition
City of Fort Collins and Poudre Fire Authority are named as additional
insureds with respects to the general liability.
a.�n t Irtvr, � r,vi.v�n
CITYFOR SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEPORE THE EXPIRATION
DATE THEREOP, THE ISSUING INSURER WILL ENDEAVOR To MAIL 10 PAYS WR1Y(EN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO 00 BO SHALL
City of Fort Collins IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
300 LaPorte Ave. REPREseKTATNOS.
Fort Collins CO 80522 Au RTz RSPRss
ACORD 2512001108) ® ACORD CORPORATION 1986
10- 5-05; 9:57AM;LBN Insurance
;970 229 1898 # 2/ 2
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endors m
If SUBROGATION IS WAIVED, sub' a ent(s).
t
require an endorsement. A statement on this certificate does nlot tions confer rights to the certiffcat�of the policy, certain es may
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.
i
P
tzoo��osl 1 w