HomeMy WebLinkAboutPINKARD - INSURANCE CERTIFICATE (10)A R OF LIABILITY
DATE/05 YY)
CERTIFICATE INSURANCE
10/04/05
�pODUCER 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.
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
1550 17th Street
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Suite 600
Denver, CO $0202
INSURERS AFFORDING COVERAGE
INSURED
Pinkard Construction
INSURER A: National Union Fire Ins. Co. AIG
INSURER B:Pinnacol Assurance
9195 West 6th Avenue
INSURER C:Zurich American Insurance Company
INSURER D:
Lakewood, CO 80215
INSURER E:
COVERAr.FS
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
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE INIMMOMI
POLICY EXPIRATION11H.
DATE (MMIDDIVY)
LIMITS
C
GENERAL LIABILITY
GL03696512-00
12/01/04
11/01/05
EACH OCCURRENCE
$1,000,000
FIRE DAMAGE (Any one fire)
$300,000
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE 1XI OCCUR
MED EXP (Any oneperson)
$ 10, 000
PERSONAL&ADV INJURY
$ 1,000,000
X BI/PD Ded: $50, 000
GENERAL AGGREGATE
$ 2,000,000
GENT AGGREGATE LIMIT APPLIES PER:
PRODUCTS-COMP/OP AGG
$2,000,000
POLICY PRO-
X LOC
C
AUTOMOBILE
LIABILITY
ANY AUTO
BAP3696513-00
12/01/04
11/01/05
COMBINED SINGLE LIMIT
(Ea accident)
$ 1, 000, 000
X
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
X
BODILY INJURY
(Per accident)
$
HIRED AUTOS
NON-OWNEDAUTOS
X
PROPERTY DAMAGE
(Per accident)
$
rl
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
$
AUTO ONLY: AGG
A
EXCESS LIABILITY
BE2911563
12/01/04
11/01/05
EACH OCCURRENCE
$ 10, 000, 000
% OCCUR CLAIMS MADE
AGGREGATE
$10,000,GOD
$
DEDUCTIBLE
$
% RETENTION $10, 000
B
WORKERS COMPENSATION AND
2321400
10/01/05
10/01/06
X WC LIMITS OTH-
EMPLOYERS' LIABILITY
E.L. EACH ACCIDENT
$ 100, 000
E.L. DISEASE - EA EMPLOYE
$ 100, 000
E.L. DISEASE -POLICY LIMIT
Is500, 000
OTHER
a
5
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Certificate Bolder is included as Additional Insured on the General Liability Coverage as required by written contract
or agreement. A Waiver of Subrogation is provided in favor of the Certificate Bolder on the General Liability Coverage
RE: Work Order# B-WRF. 2004-1 Daft Odor Control.
CERTIFICATE HOLDER I I Annnnnaal INsunpn. INsunpa I F"Fn. CANCELLATIAN
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
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
300 West La Porte Ave.
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
P.O. Box 580
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
Fort Collins, CO 80522
USA
ACORD 25-S (7/97) NEGANC o ACORD CORPORATION 1988
3477208 PDWered B