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HomeMy WebLinkAboutBRINKMAN CONSTRUCTION - INSURANCE CERTIFICATE (2)A-C__OW, CERTIFICATE OF LIABILITY INSURANCE OAT 1/1/2008 oz/u/zoos PRODUCER (970)679-7333 FAX (970)679-7377 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Ewing -Leavitt Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 4025 St Cloud Dr HOLDER THIS CERTIFICATE DOES NOT AMEND EXTEND OR Suite 100 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW Loveland, CO 80538 INSURERS AFFORDING COVERAGE NAIC # INSURED Brinkman Construction Inc INSURERA CNA _ G9124 1315 Oakridge Drive WSURERB pinnacol Assurance 41190 Suite 100 INSURER - Fort Collins CO 80525 INSURLRD ---- -- INSURE R F 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 DD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY 2094465292 02/17/2008 02/17/2009 EACHOCCURRENCE S 1 000 00 X-1 COMMEHON GILNER�ALI IAHILITV MA DAGE TO RENTED $ 100 00 CLAIMS MADE ]E OCCUR L-� MED EXP (Any one pers n) _ $ 5 00 A X Blkt WaiverSuubro PERSONAL B ADV INJURY $ 1 000 00 -XI Blkt Addl Insureds GENERAL AGGREGATE $ 2 000 00 GEN L AGGREGATE LIMIT APPLIES PER PRODUCTS COMP/OP AGG $ 2 000 00 POLICY X JECT LOG AUTOMOBILE LIABILITY 209446S275 02/17/2008 62117 22009 COMBINED SINGIF LIMIT $ ANY AUTO (Ea accident) 1 00000 ALL OWN[ OAUTOS _ _ _ _ -- IX SOUR V INJURY $ A scHEDUI ED AuI Ds (Pe Pa son) HIRFDAUIOS --- ----- --- ] UODILY INJURY $ X NON O W NFD AU I OS (Per acc dent) — — -- — PROPERTY DAMAGE $ (I in accident) GARAGE LIABILITY AUTOONLY LAACCIDENU $ ANY AUT O OTHER THAN EAACC $ AUTO ONLY AGG $ EXCESSIUMBRELLA LIABILITY 209446S289 02/17/2008 02/17/2009 EACHOCCURRENCE $ 4,000 000 X OCCUR Ll CLAIMS MADE AGGREGATE $ 4 000 00 A - — $ DEDUCTIBLE- - -- - -- $ X RETENTION $ 10 00 _ __ _ — — -- — $ WORKERSCOMPENSATIONAND 4093547 06/01/2007 06/01/2006 X pRVI MITI OTH F.B _ EMPLOYERS LIABILITY BLANKET WAIVER OF _ B ANY PROPRIEIORIPARTNLWLXFC.UUVE 1 F L EACH ACCIDENT $ Soo 000 OFFICERIMEMBER EXCLUDED' SUBROGATION EL DISEASE FA EMPLOYEE $ 500 00 It yes descrbe under SPECIAL PROVISIONS below E L DISEASE POI ICY LIMIT $ 500 000 OTHER Inland 2094465292 02/17/2008 02/17/2009 Leased/Rented Equip q p ACommercial Marine $75 000 limit subject to $1 000 deductible DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS ertificate holder IS named as additional insured as respects work performed City of Fort Collins P 0 Box 580 Fort Collins CO 80522 SHOULD ANY OF 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 MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR REPRESENTATIVES AUTHORIZED REPRESENTATIVE I Renee Stein/RESTEI "IPk �'-- .,. Wmw Lu L6V V I/YpI ©ACORD 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 e ,Wv w m rcvvvvo/