HomeMy WebLinkAboutCLARK CONSTRUCTION - INSURANCE CERTIFICATE (2)Client#: 21097
CLACO
ACORD,. CERTIFICATE OF LIABILITY INSURANCE
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r/J�_
PRODUCER
THIS CERTIFICATE IS ISSUED AS A
ATTER OF INFORMATI,ON//
Flood & Peterson Insurance Inc
ONLY AND CONFERS NO RIGHTS U
ON THE CERTIFICATE
4821 Wheaton Drive
HOLDER. THIS CERTIFICATE DOES
ALTER THE COVERAGE AFFORDED
OT AMEND, EXTEND OR
Y THE POLICIES BELOW.
P O Box 270370
Fort Collins, CO 80527
INSURERS AFFORDING COVERAGE
NAIC #
INSURED
Clark Construction Co., Inc.
2956 Ginnala Drive
Loveland, CO 80538
INSURERA: St. Paul Travelers Insura
ce Company
INSURER B: Pinnacol Assurance
INSURER C:
INSURER O:
INSURER E
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD I
DICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFI
ATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONF
AND CONDITIONS OF SUCH
POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR
NSR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE MWDD/YY
POLICY EXPIRATION
DATE MM/DD/YY
LIMITS
A
GENERAL LIABILITY
DTCO283P245A-
03/01/06
03/01/07
EACH OCC
RRENCE
S1 000000
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE a OCCUR
TIL06
DAMAGE
REMG ET
RENTED occurrence)$300
DDD
MED EXP (
ny one person)
$5 000
PERSONAL
& ADV INJURY
$1 000 000
X PCDed:2,500
GENERAL
GGREGATE
$2 000 000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS
- COMP/OP AGG
$2 000 000
POLICY X PRO-
JECT 0LOC
A
AUTOMOBILE
X
LIABILITY
ANY AUTO
DT810283P245ATIL06
03101/06
03/01107
COMBINED
(Ea accident
'INGLE LIMIT
$1 ,000 ,000
BODILY INJI
(Per person)
RY
$
ALL OWNED AUTOS
SCHEDULED AUTOS
X
BODILY INJ
(Per acciden
RY
$
HIREDAUTOS
NON-OWNEDAUTOS
X
PROPERTY
(Per acciden)
AMAGE
$
GARAGE LIABILITY
AUTO ONLY I
EA ACCIDENT
$
OTHER THA:
EA ACC
$
ANY AUTO
$
AUTO ONLY
AGG
A
EXCESS/UMBRELLA LIABILITY
DTSMCUP283P245A-
03/01/06
03/01/07
EACH OCCU11IRENCE
$1 000 000
X OCCUR CLAIMS MADE
TIL06
AGGREGAT
$1 000 000
$
$
DEDUCTIBLE
$
X RETENTION $ 10000
B
WORKERS COMPENSATION AND
4000003
04101 /05
04/01106
X I WC ST
TU- I OTH-
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
E.L. EACH A
(DENT
s500,000
E.L. DISEASE
- EA EMPLOYEE
$500,000
OFFICER/MEMBER EXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE
- POLICY LIMIT
$500,000
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
ATTN: John Stephen FAX: 221-6707 RE: Fossil Creek Park
The City of Fort Collins is named as additional insured.
(Excluding Workers' Compensation). 200611AR
9la.i 9:51
TE HOLDER
City of Fort Collins
Purchasing Dept
215 N Mason
Fort Collins, CO 80524
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAV R TO MAIL _30_ DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE EFt, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UP N THE INSURER, ITS AGENTS OR
ACORD 25 (2001108) 1 of 2 #M340436 L I JGH 0 ACORD CORPORATION 1988
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorse. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorse ent(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certair� policies may
require an endorsement. A statement on this certificate does not confer rights to he 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, Inor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
ACORD 25S (2001/08) 2 of 2 #M340436