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Home My WebLink AboutCNI CONTRACTORS - INSURANCE CERTIFICATEClient#: 52117 8CNICONT ACORDn., CERTIFICATE OF LIABILITY INSURANCE 04129/oa°"YYY' PRODUCER HRH of Colorado 720 South Colorado Boulevard Suite 60ON Denver, CO 80246 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOTAMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED CNI Contractors, Inc. 1207 South Lipan St. Denver, CO 80223 INSURER A. Mountain States Insurance Group 5900 INSURERS: Employers Compensation Insurance Co. 11512 INSURERc: Fireman's Fund Insurance Company 21873 INSURER D: INSURER E: COVERAGES 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 CONTRACTOR OTHER DOCUMENT WITI I RESPECT TO WHICH THIS CERTIFICATE MAYBE 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, INS LTR INSR TYPE OF INSURANCE POLICYNUMBER POLICY EFFECTIVE DATE (MMIDDIWI POLICY E%PIRATION DATE MMIDD/YY .w. LIMITS A GENERAL LIABILITY CPP0105277 05/01/08 05/01/09 EACH OCCURRENCE $1 00O 000 X COMMERCIAL GENERAL LIABILITY DPREMISES (Ea acconence) AMAGE TO RENTED $1 OO OOO CLAIMS MADE aOCCUR MED EXP(Any one person) $10000 PERSONAL & ADV INJURY $1 00O 000 X PD Ded:1.000 GENERALAGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCT"S-COMPIOP AGG $2000000 Pollution 250,000 POLICY r7X JFC. X LOC Jobsite A AUTOMOBILE LIABILITY ANY AUTO BAP0105277 _ 05/01108 05/01/09 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 X 80DILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS X BODILY INJURY (Peroccident) HIRED AUTOS NON -OWNED AVTOS X X PROPERTY DAMAGE (Per accident) $ Drive Other Car John/Susan Maus ACV Ded. Applies Ph sical Dama e GARAGE LIABILITY AUTO ONLY - EAACCIDENT $ OTHER THAN EA ACC S ANY AUTO S AUTO ONLY: AGG A EXCESSIUMBRELLA LIABILITY UMB0105277 05/01/08 05/01/09 EACH OCCURRENCE: $2 0OO 000 X OCCUR CLAIMS MADE AGGREGATE s2 00O 000 $ DEDUCTIBLE X $ RETENTION $ 1 O 00O B WORKERS COMPENSATION AND FN0329093 07/01/07 07/01/08 WCSTATU- OTH. EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNEWEXECUTIVE OFFICERWEMBER EXCLUDED? _X E.L. EACH ACCIDENT $5OO BOO EL. DISEASE - EA EMPLOYEE $500,000 If yes, cribe, under SPECIALS PROVISIONS be. EL DISEASE -POLICY LIMIT $500,000 C OTHER Lease/Rent MX198473957 05/01/08 05/01/09 $450,000 Install Floater Ded. Applies $1,100,000 Jobsite $100,000 Tem /Transit DESCRIPTION Or OPERATIONS I LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Re: Contractors License (See Attached Descriptions) City of Ft. Collins 300 LaPorte Avenue Fort Collins, CO 80524 LD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE T14E EXPIRATION THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL *30 DAYS WRITTEN E TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO 50 SHALL iE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 25 (2001 MR) 9 of I }YUFAWIrA '<73173�iIK�1 3(!I�q�Ti�]C�Gr�t�P6 1{yjii.. DESCRIPTIONS (Continued from Page 1) 1 This Certificate of Insurance represents coverage currently in effect and may or may not be in compliance with any written contract. * The following cancellation conditions always apply: -10 days for non-payment of premium - If policy shown, 10 days for Workers' Compensation for fraud; material misrepresentation; non-payment of premium; other reasons approved by the Commissioner of Insurance TNUGIAE in] 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 (2001/08) 2 of 3 #M582964