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HomeMy WebLinkAboutSINNETT - INSURANCE CERTIFICATEACORD CERTIFICATE OF LIABILITY INSURANCE CSR LM DATE(MWDD/YYYY) SINNE-1 PRODUCER 10 05 05 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 Sinnett Builders Inc. PO Box 1969 Fort Collins CO 80522 .....11e. �1� INSURERS AFFORDING COVERAGE I NAIC # INSURER A: EMC Insurance Com anies INSURER B: Pinnacol Assurance INSURER C: INSURER D: INSURER E: 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. LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MWDDlYY E DATE MW0D/YY I LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1 , 000 , 000 A X X COMMERCIAL GENERAL LIABILITY 3X23769-06 06/30/05 06/30/06 PREMISES(Ea o=renm) $300,000 CLAIMS MADE U OCCU4 MED EXP (Any one person) $ 5 , 000 Banket Al FORM CG7462 PERSONAL & ADV INJURY $ 1 000 000 GENERAL AGGREGATE , , $ 2 , 000 000 kG&T AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG , $ 2,000,000 POLICY PRO LOC JECT AUTOMOBILE LIABILITY A ANY AUTO 3X23769-06 06/30/05 06/30/06 COMBINED SINGLE LIMIT (Ea accident) $11000,000 X ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIREDAUTOS X NON -OWNED AUTOS BODILY INJURY (Per accident) $ X PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $5,000,000 A X OCCUR CLAIMSMADE 3X23769-06 06/30/05 06/30/06 AGGREGATE a5,000,000 a DEDUCTIBLE 10 a RETENTION $ 10 , 000 $ WORKERS COMPENSATION AND X TORY LIMITS I X ER B EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE 4045474 07 /O1 /05 07/01/06 E. L. EACH ACCIDENT $500,C00 OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ 500,000 If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $500000 OTHER A Equipment 3X23769-06 06/30/05 06/30/06 Rented or $50,000 Leased $1000 ded DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / 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. CITYFOR SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL City of Fort Collins IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 300 LaPorte Ave. REPRESENTATIVES. Fort Collins CO 80522 AU REPRES ly#, ¢ n , ACORD 25 (2001/08) ©ACORD CORPORATION 19RR 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.