HomeMy WebLinkAboutSINNETT BUILDERS - INSURANCE CERTIFICATE (12)10- 5-05; 9;57AM;LBN Insurance
;970 229 1398 # 1/ 2
ACOM. CERTIFICATE OF LIABILITY INSURANCE SICNNE-1,14 °Ato °5 0-9
PRoOucER 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, Unit 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#
RJ¢UREO - INSURER EMC Insurance Companies
INSURER B: Pinnacol Assurance _
SXnnett Builders Inc. INSURER C: �-
PO Sox 1069 INSURER O;
Fort Collins CO 80522
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN 16SUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONOMION OF ANY CONTRACTOR 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.
IN
LTR
01
NBKE
TYPE OF INSURANCE
POLICY NUMBER
P00AUTEy(1I1WFF[E§I7Vb
PODALTICOYCANGREAMNLIMrrS
GENERAL LIAINLrTY
EACH OCCURRENCE
$ 1 , 000 , 000
A
X
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE U OCCUR
3X23769-06
06/30/05
06/30/06
PREMISES UiRa OncYanee
$300 000
MED EXP{Any one person)
s 5 000
PERSONAL& ADV INJURY
_ _
$1,000,000
iianket AT
FORM CG7462
GENERAL AGGREGATE
$2 000 000
PRODUCTS-COMPIOPAGG
S2,_000.,000
6EN'L AGGREGATE LIMIT APPLIES PER:
X POLICY JECT LOD
---_,_
A
AUTOMOBILE
LIABILITY
ANY AUTO
3X23769-06
06/30/03
06/30/06
i""ad"OI}INGLELIMR
s1,000,000
X
BODILY INJURY
(Por Parson)
ALL OWNED AUT06
SCHEDULEDAUTOS
S
X
BODILY INJURY
(Per acddBnU
HIREDAUTOS
NON.OWNEDAUTOS
X
PROPERTY DAMAGE
(Par ocdidan)
S
GARAGE LIABILITY
I AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
AUTO ONLY: AGG
S
ANY AUTO
$
EXCESSAIMBRELLA LIABILITY
EACH OCCURRENCE
$ 5 , 000 , O00
A
X I OCCUR CLAIMSMADE
3X23769-06
06/30/05
06/30/06
AGGREGATES
$5, 000, 000
t
i
DEDUCTIBLE
S
X RETENTION S10000
E
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETORIPARTNERIEXECUTNE
OFFICERIMEMBER EXCLUDED?deffa
iiyyee.ALPR
S7GCIAL PROVISIONS Ce1VW
4045474
07/01/05
07/01/06
X 70RY LIMITS x ER
E.LEACH ACCIDENT
$500,000
L•L. DISEASE -EA EMPLOYEE
E.L,DISEASS- POMOYLIMIT
SSOO,000
5SO0 , 000
OTHER
A
Equipment
3X23769-06
06/30/05
06/30/06
Rented or $50,000
Leased $1000 ded
USBCRIPTION OF OPEIIATIONS I LOCATIONS! VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Project: General Contractor for Fire Station Expansion; P-872:
Fire Station $5 Addition
City of Fort Collins Arid Poudre Fire Authority are named as additional
insureds With respects to the general liability.
, S:K I Inv^ I e nVLUMM 4rNwaV1.,IM1rvi•
CT,1 rOR SHOULD ANY OF THE ABOVE DFOORID90 POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE TNEREOP, 711E ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WPJY191M
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO 90 SO SHALL
City of Fort Collins IMPOSE NO OBLIGATION OR MA131LJYY OF ANY HIND UPON THE INSURER, ITS AGENTS OR
300 LaPorte Ave. REPRESRNTATNES.
Fort Collins CO 80522 Au �FR G
ACORD 25 (2001/081 T 0 ACORD CORPORATION 1988
10- 5-05; 9:57AM;LBN Insurance
;970 229 1398 # 2/ 2
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.