HomeMy WebLinkAboutTWIN PEAKS UTILITIES - INSURANCE CERTIFICATEAC RQ: CERTIFICATE OF LIABILITY INSURANCE
DATE (MMIDD/YY)
07/18/06
PRODUCER 1-303-534-4567
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
The INA Financial Group, Inc.
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
INA of Colorado, Inc.
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
1550 17th Street
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Suite 600
Denver, CO 80202
INSURERS AFFORDING COVERAGE
INSURED
Twin Peaks Utilities & Infrastructure, Inc.
INSURER A: National Union Fire Ina. Co. of PA (AIG)
INSURER B: Pinnacol Assurance
1500 Overlook Drive
INSURER C: Bituminous Casualty Corporation
INSURER D: Bituminous Casualty Corporation
Lafayette, CO 80026
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.
INSR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE 1NIM/DD1YY1
POLICY EXPIRATION-LIEL
DATE (MNVDDNY1
LIMITS
D
GENERAL LIABILITY
X COMMERCIAL GENERALUABILITY
CLAIMS MADE a OCCUR
X BI/PD DED: $2,000
CLP3226676
04/10/06
04/01/07
EACH OCCURRENCE
$ 1,000,000
FIRE DAMAGE (Anyone fire)
$300,000
MED EXP (Any one person)
$ 5, 000
PERSONAL& ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 21000,000
GENT AGGREGATE LIMIT APPLIES PER:
POLICY X PRC LOC
PRODUCTS-COMP/OP AGG
$2,000,000
C
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIREDAUTOS
NON -OWNED AUTOS
CAP3504751
04/10/06
04/01/07
EaaccideD)INGLELIMIT
$1,000,000
X
BODILY INJURY
(Per Person)
$
X
BODILY INJURY
(Per accident)
$
X
PROPERTY DAMAGE
(Per accident)
$
GARAGELIABILITY
ANY AUTO
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
AUTO ONLY: AGG
$
$
A
EXCESS LIABILITY
X OCCUR CLAIMS MADE
DEDUCTIBLE
X RETENTION $10,000
BE9306403
04/05/06
04/01/07
EACH OCCURRENCE
$ 2,000,000
AGGREGATE
$ 2,000,000
$
B
WORKERS COMPENSATION AND
EMPLOYERS' LABILITY
4103471
09/05/06
04/01/07
X r/✓C STATU- OTH-
E.L. EACH ACCIDENT
$ 500,000
E.L. DISEASE - EA EMPLOYEE
$ 500,000
E.L. DISEASE - POLICY LIMIT
$500,000
OTHER
a
s
$
DESCRIPTION OF OPERATONSILOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
RE: License. City of Fort Collins is included as Additional Insured on the General Liability Policy as
required by written contract or agreement and with respect to work performed by Insured.
City of Fort Collins
PO Box 580
SHOULD ANYOF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 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 INSURER, ITS AGENTS OR
Fort Collins, CO 80522-0580 I AUTHORIZED REPRESENTATIVE Qr ,�
USA " �B��
SDZN (a
soiszaU
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.