HomeMy WebLinkAboutTEMPLE CONSTRUCTION - INSURANCE CERTIFICATE (4)DATE
ACORD.M CERTIFICATE OF LIABILITY INSURANCE 03/31/06Dm)
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Van Gilder Insurance Corp. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
700 Broadway, 1000 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
Y ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Denver, CO 80203
303 837-8500 INSURERS AFFORDING COVERAGE
INSURED INSURERA: Travelers Indemnity Company (CL)
Temple Construction Company, LLC INSURER B: Pinnacol Assurance
1404 Duff Drive
INSURER C:
Fort Collins, CO 80524
INSURER D: _
INSURER E:
rnVFRAnFC
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
LT
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
ATE MM D
POLICY EXPIRATION
DATE M D
LIMBS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE 51 OCCUR
X PD Ded:2,500
DTC09684A9151ND
04/01/06
04/01/07
EACH OCCURRENCE
$1 000 000
FIRE DAMAGE (Anyone fire)
_
$300000
MED EXP (Any one person)
$5 000
PERSONAL & ADV INJURY
$1 000 000
GENERAL AGGREGATE
$2 000 000
GEN'L AGGREGATE LIM ITAPPLIES PER:
POLICY [XI PECoi LOC
PRODUCTS-COMPIOPAGG
$2000000
A
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
DT8109684A915
04/01/06
04/01/07
COMBINED SINGLE LIMIT
(Ea accident)
$1,000,000
X
BODILY INJURY
(Per person)
$
X
BODILY INJURY
(Per accident)
$
X
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
ANY AUTO
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
AUTO ONLY: AGG
$
$
EXCESS LIABILITY
OCCUR El CLAIMS MADE
DEDUCTIBLE
RETENTION $
EACH OCCURRENCE
$
AGGREGATE
$
a
$
B
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
4079866
04/01/06
04/01/07
X WC STATUS OTH-
E.L. EACH ACCIDENT
$500,000
E.L. DISEASE -FA EMPLOYEE
$500,000
E.L. DISEASE -POLICY LIMIT
$500,000
A
OTHER Leased,
Rented, Borrowed
ui ment I
QT6607385B257
I
04/01/06
04101/07
$250,0001 Limit
Subject to $1,000
Deductible
DESCRIPTION OF OPERATIONSILOCATIONSAIEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
RE: Sanitary Sewer Project
City of Fort Collins is included as Additional Insured under General Liability, as required by written contract.
City of Fort Collins
Purchasing Division
PO BOX 580
Fort Collins, CO 80522
SHOULD ANYOF TH E ABOVE DESCRIBED POLICIES B E CANCELLED BEFORE TH E EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TOMAILAO DAYSWRRTEN
NOTICETOTHE CERTIFICATE HOLDER NAMED TOTH E LEFT, BUTFAILURE TODOSOSHALL
IMPOSE NOOBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURERJTS AGENTS OR
REPRESENTATIVE
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