HomeMy WebLinkAboutPINKARD - INSURANCE CERTIFICATE (11)The INA Financial Group, Inc.
INA of Colorado, Inc.
1550 17th Street
Suite 600
Denver, CO 80202
City of Fort Collins
300 Nest La Porte Ave.
P.O. Sox 580
Fort Collins, CO 80522
USA
USA
This document was brought to you by Certi£icatesNow.
If you have questions regarding the content of this document, please contact
the Producer/Agent listed on the certificate of insurance.
cc:
The data included in this notice and in the attached document is confidential to ConfirmNet
and the party responsible for bringing you this information.
Powered ByCertificafesNowT"
0/27MMOMCERTIFICATE OF LIABILITY INSURANCE MND VY)
10/27/OS
PRODUCER 1-303-534-4567 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
1The 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 I ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Suite 600
Denver, CO 80202
Pinkard Construction
INSURER B:
9195 West 6th Avenue
INSURER C:
Lakewood, CO 80215 INSURER D:
INSURER E:
nnveewr_oe
INSURERS AFFORDING COVERAGE
Pinnacol Assurance
Zurich American Insurance
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 (MMIDDIM
POLICY EXPIRATION.LIEL
DATE fMUMDNY)
LIMITS
C
GENERAL LIABILITY
GL0369651201
11/01/05
11/01/06
EACH OCCURRENCE
$ 1,000,000
FIRE DAMAGE (Any one tire)
$300,000
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE Fx� OCCUR
IVIED EXP Any one person)
$ 10, 000
PERSONAL &ADV INJURY
$ 1, 000,000
X SI/PD Ded: $50, 000
GENERAL AGGREGATE
$ 2,000,000
GENL AGGREGATE LIMIT APPLIES PER:
PRODUCTS-COMP/OP AGG
$2,000,000
POLICY X PRO- LOC
C
AUTOMOBILE
LIABILITY
ANY AUTO
BAP369651301
11/01/05
11/01/06
COMBINED SINGLE LIMIT
(Ea accident)
$ 1, 000, 000
X
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
X
BODILYINJURY
(Per accident)
$
HIRED AUTOS
NON -OWNED AUTOS
X
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EAACC
$
ANYAUTO
$
AUTO ONLY: AGG
A
EXCESS LIABILITY
BE7227742
11/01/05
11/01/06
EACH OCCURRENCE
$ 10,000,000
X OCCUR 1-1 CLAIMS MADE
AGGREGATE
$ 10, 000, 000
$
DEDUCTIBLE
$
X RETENTION $10,000
ISWORKERS
COMPENSATION AND
2321400
10/01/05
10/01/06
OTH-
X WC STATU-F EEL
EMPLOYERS' LIABILITY
E.L. EACH ACCIDENT
$ 100, 000
E.L. DISEASE - EA EMPLOYEd
$ 100, 000
E.L. DISEASE -POLICY LIMIT
Is500, 000
OTHER
3
S
5
DESCRIPTION OF OPERATIONSALOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Certificate Holder 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 Holder on the General Liability Coverage
RE: Work Order$ H-WRF. 2004-1 Daft Odor Control.
2005NOU 3 010:04
rcGTICIr ATC Yn1 nCO I I.nn...,..,u w e ,e f%AMCCI I ATInW
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 e4.jr&_�
Fort Collins, CO 80522
USA
AGORD 25-5 (7/97) MEGANC 0 ACORD CORPORATION 1936
3562004
Powered ByCertificafesNowTM
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.
(7/971