HomeMy WebLinkAboutTEMPLE CONSTRUCTION - INSURANCE CERTIFICATE (2)DATE
ACOR®,., CERTIFICATE CIF LIABILITY INSURANCE I 03128/08°m'
PRODUCE:R. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Van Gilder Insurance Corp. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
700 Broadway, Suite 1000 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW,
Denver, CO 80203
303 837.8500 INSURERS AFFORDING COVERAGE
INSURED
Temple Construction Company, LLC
1404 Duff Drive
Fort Collins, CO 80524
COVERAGES
INSURERA Travelers Indemnity Company (CL) _ _ _
INSURERS: Plnnacol Assurance
INSURER C:
INSURER D:
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
LTR
TYPE OF INSURANCE
(POLICY
POLICY NUMDER
EFFECTIU�POLICV
DATE MMIDDIYY
E%PIRA?ION I
DATE MMIDD/YV
LIMITS
A
GENERAL LIABILITY
DTC09684A9151ND08
04/01/08
04/01/09
EACH OCCURRENCE
$1,000000
FIRE DAMAGE (Any one G,e)
_—..
$300,000
X�COMMERCIAL GENERAL LIABILITY
MED EXP (Any one person)
$5,000
—I—_I CLAIMS MADE [ X_) OCCUR
X PD_Ded:2,500
PFRSONAL&ADVINJURY
$1 000,000
----------
-- --
GENERAL AGGREGATE
$2 000,OOO _
GENT AGGREGATE L IM ITAPPL IES PER:
PRODUCTS=COMPIOPAGG
$2,000,000
POLICY) X I Ipm 1 LOC
j
A
AUTOMOSILELIABILITY
ANY AUTO
ALL OWNED AUTOS
DT8109684A915TIL08
04/01/08
04/01/09
conaBmeDswGLEUMIT
(Ea aco a'p
$1,000,000
'
BODILY INJURY
"{
SCHEDULED AUTOS-F_--------
(Per person)
XI HIRED AUTOS
X�i NON -OWNED AUTOS
BODILY INJURY
(Per accident)
$
_
PROPERTY DAMAGE
(Per accident)
$
LIABILITY
AUTO ONLY - EA ACCIDENT
It
OT'HERTIIAN EA -ACC
AUTO ONLY'. AGO
$
_GARAGE
ANY AUTO
-
1
$
EXCESS LIABILITY
EACH OCCURRENCE
$
-A(GREGATE
$
OCCUR -j CLAIMS MADE
DEDUCTIBLE
B
WORKERS COMPENSATION AND
4079866
04101 /08
04/01/09
T X V✓C STATU- -1 1DTH-
JT05Y11G7LLS._ _- - ��
EMPLOYERS' LIABILITY
E.L.EACHACCIDENT
$5001000
EL DISEASE -EA EMPLOYEE
s500,000
E.L. DISEASE -POLICY LIMIT
$500,000
A
OTHER Leased,
QT6607385B257TILOB
04/01/08
04/01/09
Limit $250,000
Rented, Borrowed
(Equipment
!
�_
Subject to $1,000
Deductible
_
DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
RE: Sanitary Sewer Project
City of Fort Collins is included as Additional Insured under General Liability, as required by written contract.
City of Fort Collins
Purchasing Division
PO Box 580
Fort Collins, CO 80522
SH OULD ANYOF TH E ABOVE D ESCRIBE D POLICIES B E CANCELLED B EFORE TH E EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TOMAIL30__ DAYSWRITTEN
NOTICE TO THE CERTIFICATE H OLDER NAM ED TO TH E LEFT, BUT FAILURE TO DO SO SH ALL
IM POSE NO OB LIGATION OR LIABILITY OF ANY KIND UPON THE INS U RE R,ITS AGENTS OR
A,IQzHORIZED REPRESENTATIV
ACORD 25-S (7/97)1 of 2 #M527673 nL I "'"' ��'���'"" ""' """
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 25-S(7/97)2 of 2 4fMS276'/3