HomeMy WebLinkAbout398304 LAUREL HILL GIS - INSURANCE CERTIFICATE (3)ACORQ CERTIFICATE OF LIABILITY INSURANCE
FMmxwYYM
08/29/2006
nROD xm 303 939-99 1 FAX (303 939-9926
Herbert -Leavitt Longmont
275 South Main Street
Suite 208
Longmont, CO 90501
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
AL�TTHEECCOVE AFFORDED BYTTHE AMEND,ND OR
BELOW.
INSURERS AFFORDING COVERAGE
NAIL #
INSURED Laurel Hi I 1 615 Inc
307 Bross St
Longmont, CD 80S01
INSURERA: Maryland Casualty Company
193SG
INSURERB Pinnacol Assurance
INBURERc Philadelphia insurance Co
INSURER Or.
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 POLICES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAD CLAIMS
TYPE OF SMSIIRANCE
POLICY HUMBEI
EFFECTIVE
LIMITS
GENERAL LIABILITY
PP5037575108
02/01/2
02/01/ZO07
EACH OCCURRENCE
$ 1,000,000
X COMMERCIAL GENERAL UIME Y
DAMAGETORElTM
$ 1,000,0001
MEDEXP(AWy pa )
$ 10,0001
CUAMSMADE OOCCUR
A
PERSONAL a ADV INJURY
_
$ EXcl M
GENERAL AGGREGATE
$ 21000,
GENL AGGREGATE LMITAPPLIES PER:
PRODUCTS-COMFYOPAGG
$ 2.000.00(
POLICY JE�CT El LOC
AUTOMOBILE LEA NUTY
ANY AUTO
PP5037575108
02/6l/2006
02/01/2007
COMBINED SINGLELMIT
(Ea 90d°R'R)
$
1,000
BODILY INJURY
(PwP)
$
A
ALL OWNEDAUTOS
SCHEDULED AUTOS
X HIREDAU IDS
X NGFOMEDAUTOS
BODLYIN.IURY
Mwa=k%M
$
PROPERTY DAMAGE
(PERacciaant)
$
GARAGE LIABILJTY
AUTO ONLY -EA ACCIDENT
$
OTHERTHAN EAACC
AUTDONLY: AGG
S
ANYAUTO
$
MICESSIIN/REILLA UABRJTY
EACH OCCURRENCE
$
OCCUR CLAIMS MADE
AGGREGATE
$
S
S
DEDUCIBLE
S
RETENTION $
4091796
04/01/2006
04/01/2007
X "rSTAT11 OTRI-
1
EL EACH ACCIDENT
$ 500
B
IWORICERSOOMPENSATIONAND
EMPLOYERS' LIABILITY
MY PROPRIErORIPARTNER11DUBOUTIVE
OFFK39WEMSM EXCLUDED?
E.L. DISEASE- EA EMPLOYEE
$ 5OO
M. �P O=S bHow
E.L. DISEASE- POLICY LIMIT
S 500
C
LOTHER
rrors 8 Omissions
r
PHSD160401
10/26/2005
10/26/2006
$1,000,000 per Claim
1,000,000 Aggregate
I
I
I
I 27,S00 Deductible
DEscwHON OFOPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADD® BY ENDORSEMENT SPECIAL PROVISIONS
ll Locations / All Operations
Pti�A1 Y I eA\M!CI I ATWW
SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE
EAPIRATION DATE THEREOF, THE MUM POURER VRLL ENDEAVOR TO MAR
City of Fort Collins
Attn: John Stephens
30 DAYS IOUTTE"H°flCE TO THE CITE HOLDER MIN® TD THE uwr,
BUT FABLRE TO MAIL SUCH NOTICE SHALL BPOSE NO OBLIGATION OR LIABILITY
PO BOX 58O
OF AM KOD UPON THE BOURER, ITS AGENTS OR R OftM TAm1EL
AUTHOMM REPRESENTATIVE
De metra Rafe DERAME �ae'.eI` '� IT I
Fort Collins, CD $0522
ACORD 25 (2007A1h CACORD CORPORATION 1055
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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 irrsurer(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 25 (2001100)
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