HomeMy WebLinkAboutCARNES - INSURANCE CERTIFICATE5/30/2006 9:16 AM FROM: JCB TO: 2216707 PAGE; 001 OF 002
ACORD. CERTIFICATE OF LIABILITY INSURANCE
DATE(MIAA)D/YYYY)
O5/23/2006
PRODUCER (970) 484-2805
John C. Beckett 6 Associates, Inc.
220 Smith Street
Ft. Collins CO 80524-
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
NAIL#
INSURED
Carnes Services, LLC
PO BOX 1258
Wellington CO 80549—
INSURERA:Burlington Insurance CO
INSURER Northland Insurance
INSURERC. Pinna Ol Assurance
INSURER D.
INSURER E'
COVERAGES
THE POLICIES OF INSURANCE LISkED 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 V1kOCH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,
THE VNSURA14CE AFFORDED BY ITHE 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
LTR
DO'L
INSRD
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE (MMIDDIYY)
POLICY EXPIRATION
DATE (MMIDl
LIMITS
A
GENERAL LIABILITY
/ /
/ /
EACH OCCURRENCE
$ 1,000,000
X COMMERCIALGENER LIABILITY
DAMAGE TO RENTED
PREMISES Ea occurrence
$ 1,000,000
MEDEXP(Any onepersoR)
$ 5,000
CLAIMSMADE X occuR
210BR00033
02/27/2006
02/27/2007
PERSONAL &ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2,000,000
/ /
/ /
GEN'L AGGREGATE LIMIT APPLIES PER
PRODUCTS - COMPIOP AGG
$
X POLICY JPERCT LOC
B
AUTOMOBILE
LIABILITY
ANY AUTO
CT129847
/ /
/ /
COMBNED SINGLE LIMIT
(Eaamdent)
$ 1,000,000
ALL OWNED AUTOS
09/18/2005
09/18/2006
BODILY INJURY
X
SCHEDULED AUTOS
Per person)
$
HIREDAUTOS
NON -OWNED AUTOS
/ /
/ /
BODILY INJURY
(Per accident)
$
PROPERTY DAMAGE
(Per acadent)
$
GARAGE LIABILITY
AUTO ONLY - EAACCIDENT
$
ANY AUTO
0
NO COVERAGE
I /
/ /
OTHER THAN EA ACC
$
$
AUTO ONLY: AGG
EXCESSIUMBRELLA LIABILITY
NO COVERAGE
/ /
/ /
EACH OCCURRENCE
$
AGGREGATE
$
OCCUR CLAIMS MADE
$
DEDUCTIBLE
$
RETENTION $
C
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETOWPARTNER/EXECUTIVE
4056971
05/01/2005
05/01/2006
X TORYLIMITS ER
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EAEMPLOYEE$
1,000,000
OFHCERIMEMBER EXCLUDED?
If yes describe under
SPECIAL PROVISIONS below
% /
% %
E.L. DISEASE -POLICY LIMIT
1, 000 000
$ ,
OTHER
NO COVERAGE
DESCRIPTION OF OPERATIONSLOCATIO NEHICLESIEXCLUSIONS ADDED BY ENDORSEMEN71SPECIAL PROVISIONS
FOR PROJECT IEGLER ROAD AND KICHTER ROAD ROUND ABOUT.
(970) 221-6760 (970) 221-6707
Attn: guetin Eggan
City of Fort Coilins/ Engineering Dept
PO Box 580
281 North College Avenue
Fort Collins CO 80522-
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WALL ENDEAVOR TO MAIL
10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT
FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
AUTHORIZED REPRESENTATIVE
A{�ul LO (LUU11uu) CACORD CORPORATION 198V
*T,f INS025 (ofn) 05 ELECTRONIC LASED. FORMS, INC-(g00)327-0545 Page 1 of 2
5/30/2006 9:16 AM FROM: JCB TO: 2216707 PAGE: 002 OF 002
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 after the coverage afforded by the policies listed thereon.
A{�cvrtu za tzuuvusi
*,,. INS025ww o5 Page 2 of 2