HomeMy WebLinkAboutCOFFMAN AND LAUB - INSURANCE CERTIFICATEACORDnw CERTIFICATE OF LIABILITY INSURANCE 6/15/06 D/YYYY)
C osns/os
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Flood & Peterson Insurance Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
4821 Wheaton Drive HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P O Box 270370
Fort Collins, CO 80527 INSURERS AFFORDING COVERAGE NAIC #
INSURED INSURER A: Allied Insurance
Coffman and Laub Construction Inc. INSURER B: Pinnaco) Assurance
60 Gateway Circle
INSURER C:
Berthoud, CO 80513
INSURER D:
INSURER E:
CAVFRARFS
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 POLICYMMFDDTIYE
POLICY
DATE MMIDDIYY EXPIRATION
LIMITS
A
GENERAL LIABILITY
ACP7521585463
06/22/06
06/22/07
EACH OCCURRENCE
$1000000
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE a OCCUR
DAMAGE TO RENTED
s100 000
MED EXP (Any one person)
$5 000
PERSONAL B ADV INJURY
$1 00D 000
GENERAL AGGREGATE
s2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
s2,000,000
1-1 POLICY PROECT LOC
J
A
AUTOMOBILE
LIABILITY
ANY AUTO
ACP7521585463
06122/06
06122/07
COMBINED SINGLE LIMIT
(Ea accident)
$1 ,000 ,LIDO
X
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULEDAUTOS
X
BODILY INJURY
(Per accident)
$
HIREDAUTOS
NON -OWNED AUTOS
-
X
PROPERTY DAMAGE
(Per accident)
$
GARAGE LABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
$
AUTO ONLY: AGG
A
EXCESSIUMBRELLA LIABILITY
ACP7521585463
06/22/06
06/22/07
EACH OCCURRENCE
s2,000,000
X1 OCCUR O CLAIMS MADE
AGGREGATE
s2,000,000
$
DEDUCTIBLE
$
RETENTION $
B
WORKERS COMPENSATION AND
4022750
06/01/06
06/01/07
X WCSTATU- OTH-
MTj
EMPLOYERS'LIABIUTY
ANY PROPRIETOR/PARTNER/EXECUTIVE
E.L. EACH ACCIDENT
$1,000,000
E.L. DISEASE - EA EMPLOYEE
$1,000,000
OFFICERIMEMBER EXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE -POLICY LIMIT
—
$1 ,000,000
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES! EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Certificate holder is named as additional insured (Excluding workers
compensation).
2$064Fi)N16 kM 9:47
City of Fort Collins
PO Box 580
Fort Collins, CO 80522
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE IS LING INSURER WILL ENDEAVOR TO MAIL �0._ DAYS WRITTEN
NOTICE TO THE CERTIFI ATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NOOB4.IGAT NOR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
ACORD 25 (2001108) 1 of 2 #S349496IM349494 I F tI KLB 0 ACOJRD CORPORATION 1988
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.
ACORD 25S (2001/08) 2 of 2 #S349496/M349494