HomeMy WebLinkAbout103009 PORTER INDUSTRIES INC - INSURANCE CERTIFICATE (9)A_COR.D,. CERTIFICATE OF LIABILITY INSURANCE pORTE Cl DA E( MIIIOBDNYYY)
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
LEIN Insurance Agency HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
4848 Thompson Pkwy ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Johnstown CO 80534
Phone:970-635-9400 Fax:970-635-9401 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: .
.--- ..—._........_.......__..._ . __.. _.
INSURER B Pinnacol Assurance
Porter Cheryl
Kendrick
Inc. - _-
Attn: Cher 1 Kendrick msuaFRc
Love Grani e Street wsuRERD
Loveland CO 60537 .... .......__-.__�..� ._.... ... -------------- ___._ _....._ _.....
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR 71IS 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" _..___�_�. ._....... ......
POLICY EffEDTIVE D�ICY EXPIRATION- --
LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MMIDD/YY DATE MMIDOM' LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$1,000,000
A
COMMERCIAL GENBRALLIABILITY
39UUNTX0464
04/30/08
04/30/09
PR MIs S�E-aou�.nrs
5 00,000
CLAIMS MADE ["] OCCUR
Ix
MED EXP (Any one person)
$ 10 , 000
Blanket Waiver
PERSONAL S AOV INJURY
$1,000 000
_..
Blanket Addll Ins
GENERALAGGREGATE
s21000,000
GEN'L AGGREGATE LIMIT APPLIES PER :
PRODUCTS-COMP/OPAGG
S_2 000,000
v POLICY X JE? I LOC
Emp Hen.
1,000,000
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
S1,000 000
A
X
ANY AUTO
34UUNTX0464
04/30/08
04/30/09
A
ALL OWNED AUTOS
BODILY INJURY
S
SCHEDULEDAUTOS
(Per person)
A
X
HIRED AUTOS
801O
$
A
X
NON -OWNED AUTOS
(Per aCCitlonl)enl)
A
X
Blanket Waiver
PROPERTY DAMAGE
(Per accitleDl)
GARAGE LIABILITY
AUTO ONLY - F.A ACCIDENT
$
OTHER UIAN EA ACC
$�
ANY AUTO
AUTO ONLY: ABC
$
EXCESSNMBRELLA LIABILITY
EACH OCCURRENCE
$
_] OCCUR n CLAIMS MADE
AGGREGATE..
$
5
_. DEDUCTIBLE
...........___._..__
$
RETENTION S
S
WORKERS COPAPENSA71ONAND
X T8T LIMITS ER
B
EMPLOYERS' LIABILITY
4038253
07/01/08
07/01/09
EL. EACH ACCIDENT
-
s1,000, 000
ANY PROPRIETORIPARTNERIEXECVTIVE
IMEMBER EXCLUDED?
Oyes,
-- - -
EA - DISEASE- EA EMPLOYEE
$ 1 , OOO , OOO
do
If SPF. f,IAI. PROVISIONS UeIow
E.L. DISEASE - POLICY OMIT
$1,000 000
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES / EXCLUSIONS ADDED DV ENDORSEMENT I SPECIAL PROVISIONS
All Operations - All Locations The Certificate Holder is listed as
Additional Insured in regard to the General Liability.
CERTIFICATE HOLDER CANCELLATION
City of Ft. Collins
Purchasing Dept,
Attn: Kristine
215 N. Mason
Fort Collins CO 80524
ACORD 25
FTCOLLI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO $0 SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
ACORD,,, CERTIFICATE OF LIABILITY INSURANCE GP ID RG DATE (MMIDDN"Y)
PORTE-1 04 28 08
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
LBN Insurance Agency
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
4848 Thompson Pkwy
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Johnstown CO 80534
Phone:970-635-9400 Fax:970-635-9401
INSURERS AFFORDING COVERAGE
NAIC#
...�.....__ .. _....___..
INSUNED
_..__....... __ - .........._ __.._..__.
INSUREPA' The Hartford
_. _.....
INSURER B: Plnnacol Assurance
Otter Inc.
he yltries,
Attn: Cheryl Kendrick
INSURLRC'.
_$URE __......�..._
Granite Street
wsuRER D'
Love
Loveland CO 80537
......... ..— ... ....... _—_
........ .....
COVERAGES
IIE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE 114SURED 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 THEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSRADD'- ""-"- - POLICY EFFECTIVE POLICY EXPIRATION - --- -�— 1-1.. ---�-- --
LTR INSR TYPE OF INSURANCE POLICY NUMBER DATE rMIOD" DATE MMIODIVY LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$1,000,000
A
X COMMERCIAL GENERAL LIABILITY
34UUNTX0464
04/30/08
04/30/09
"DAN$A73SO BELTED
PREMISLS(Eaoc<rence)
.-`.-..
5300,000
�
CLAIMS MADE OCCUR
MED ESP (Any one person)
S 10,000
PERSONAL B AOV INJURY
$1,000,000
X Blanket Waiver
$ 2 000, 000
X
Blanket Add' 1 Iris
GENERAL AGGREGATE
GEN'L AGGREGATE LIMIT APPLIES PER.
PRODUCTS - COMPIOP AGO
52,000,000
_._. PRO. ._
POLICYX JECT LOC
Emp Ben.
1,000,000
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
S1 OOO OOO
_X
A
ANY AUTO
34UUNTX0464
04/30/08
04/30/09
(Ea acridenq
r +
ALL OWNED AUTOS
BODILY INJURY
SCHEDULED AUTOS
(Per person)
$
A
X
HIRED AUTOS
BODILY INJURY
A
X
NON OWNED AUTOS
(Pet accldonl)
S
A
X
Blanket Waiver
...._._.
___ ......._...._.. .. _.__..
PROPER IY DAMAGE
S
(Per aocidonl)
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
S
ANY AUI'O
AUTO ONLY: AGO
$
EXCESSIUMBRELLALIABILITY
EACH OCCURRENCE..
$
OCCUR CLAIMS MADE
AGGREGATE
S
5
$
DEDUCTIBLE
RETENTION
1
$
WORKERS COMPENSATION AND
X TNY LIMITS ER
B
EMPLOYERS'LIABILI7Y
4038253
07/01/08
07/01/09
-- 1."
CICACHACCTENT
---'"-""
$1,000,000
ANY PROPRIE'I'ORIPARTNERIEXECUTIVE
....._...... _..._
.............
OFFICERIMEMBER ERCLUDEO?
E.L. DISEASE - EA EMPLOYEE
S I , 000 , 000
If yes, deoo,ibe antler
S1, 000, 000
SPECIAL PROVISIONS below
EL.DISEASE - POLICY LIMIT
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT SPECIAL PROVISIONS
All Operations - All Locations
4CR I IC'II,A I C MULUMM UAJNCULJ H I IUIN
CITYFT3 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
City of Fort Collins IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
P.G. Box 580 REPRESENTATIVES.
Ft. Collins, CO 80524 AUT lye MYRESEVI,�T% nw ui• Ale. n.F
1988
CERTIFICATE OF LIABILITY
INSURANCE
Ro
THIS CERTIFICATE IS ISSUED AS A MAT
ce Agency
rJohnstown
ONLY AND CONFERS NO RIGHTS UPON
HOLDER. THIS CERTIFICATE DUES NOT
on Pkwy
ALTER THE COVERAGE AFFORDED BY'
O 80534
INSURERS AFFORDING COVERAGE
635-9400 Fax:970-635-9401
-
INSURERa The Hartford
Porter Industries, Inc.
INSURER.: Pinnacol Assurance
Attn: Cher 1 Kendrick
INSUfI(1 D:
-- -------------
5202 Grani o Street--
_INSURER D:
Loveland CO 80537
DATE IMMfODJYYYYI
NAIC I!
I tic POLICIES OF INSURANCE LISTED BELOW I IAVH SEEN ISSVGD TO THE MSURBO NAMED ABOVE- FOR THE POLICY PERIOD WDICA'IEO.
NOTWITHSTANDING
ANY REOUIREMEN 1', TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH IICSPLCT TO WHICI I THIS CERTIFICATE MAY BE ISSUED OR
MAY Pf ItIARL THE INSURANCE AFFORDED BY'I HE POLICIES DESCRIBED HEREIN IS
SUBJECT TO ALA. THE TERh1S, CXCI.USIONSAND CONDITIONS
POLICIES. AGGREGATE LIMITS SHOWN ?JAY HAVE BEEN REDUCED BY PAID CLAIMS.
OF SUCH
IN.R RANGE _._.. .R
-
LTR NSR TYPBILITY INSURANCE POLICY NUMpEk
POLICY EFFECTIVE" P011Z'4E�RATIDN ------"""—"'—'
-- --_---
—�— ..R
DATE NHAIDO DATE MMADDAY LIMITS
GENERAL LIABILITY
FACHOCCURRENCE
$1(000 ,_O0Q
A
X COMVTRCIAL 6fNl ltAL LIABILITY
--
CLAI`A$MADF X OCCUR
34WNTXO464
04/30/08
04/30/09
'AMAC ETO RLNIED
PRCMI EU __- c 1 rQ)
--
$ 300 000
Ma) FXP IA, ono IF l)
--
$10,000
X Blanket Waiver
_
PLItSONM1I ftAOV INJURY
Sir000 ODQ
X Hlankot Addll Ins
--'
S Ze OOQ OOO
.. _____....___�_-
GENERAL AGGREGATE
EN'LACGRf:GALIf APPLIES PER:
POLICY Ix -1 Ati
�FRO.
PRODUCTS-CON.P/OP AGG
-
§2 OOO OOG
T000
IJFCT I LOC
Emp Mien.
1,000
AUTOMOBILE LIA81LITY
—
A
X ANYAUJO
34UUNTX0464
04/30/08
04/30/09
COMBINED SINGLE LIMIT
E1, 000,000
ALL OWNEO AUTO$
-
-----
_ SCHEDULED AUTOS
BODILY INJURY
P PenmB
$
A
X_ HIRED nuros
_____._...,..._......__.._
......_._....
A
X_ NON OWNED AUTOS
BODILYINJUNY
(POI acodow)
-
S
A
X Blanket Waiver
DAIAAGF:
P
.._...___...__...,._...,,.
$
8f.at1TY
(Yet actltlrnt)
(
GARAGE LIABILITY
--'---
"—
AUTO ONLY. EAACC(DENT
E
ANYAV'fU
......-.._..._..._..._. _...__.._
OTHER THAN RA ACC
—`..._.....
S
.. ____...__—_
—
__
AUTO ONLY: AGG
§
E%CESSNM1IBRELLA LNBILITY
__ ----
-
EACH OCCVRREN(EE
g
OCCUR f CLAIMS Idm
-"- __ _-----------------
--
AGGRE(SATE
S
_
S
_
WORKERS COIAPENSAt ION AND
a[R
$
B EMPLOYERS LIABILITY
X TORV LRIIT$
---
ANY PROPRIETORWARTNERIEXCCUTIVF, 4038253
OPIhCERIMEMRER C%CLUDED9
--
07/01/08 07/Ol/09 F.A. IACI I ACCIDENT $1,000 000
— -- --
If Y.6.AOSUlh 6
G_L_DI$EASE -FA TiMP1.0YEE
§ 1, Q Q Q Q QQ
SPEC
SPECIAL PROVISIONS hdoly
.
'
,
-
OTHEREL
-
OISI'AS[POLICY LIMIT
E 1, OOQ QOO
DESCRIPTION OF OPERATIONS I LOCATIONS ( VEHICLES I E%CLUSIONS ADDED OY ENOORSEMENTI SPECIAL PROVISIONS
All Operations - All Locations
CERTIFICATE HOLDER
,.... _ _........
CITYET3 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYSWRITTEN
City OF Ft Collins NOTICE TO THE CERTIFICATE HOLDER NA1IE0 TO THE LEFT, BUT FAILURE TO DO SO SHALL
Northside IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
P.O. BOX 580 REPRESENTATIVES,
Ft. Collins, CO 80524 ALIT IZQp REjgE88y,1'ATIVR
a
I°nY-01-2008 10:38 From: To:Cit'U of Fort Collins P.V2
acoao,. CERTIFICATE OF LIABILITY INSURANCE OP IOm GG, Da E(MmroDrcvrrl
LEN insurance Agency
4848 Thom son Pkw
Johnstown CO 80534 p
Phone:970-635-9400 Fax:970-635-9401
INSURED .-__-_____._____.._.__....._..._.__,..._NAIC
�1I /uvu bumrtHS NO RIGHTS UPON THE CERTIFIC,
HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEI
ALTER THE COVERAGE AFFORDED BY THE POLICIES I
AFFORDING COVERAGE
_
/P
ATha Hartford
Porter Industries, Inc.
Cheryl Kendrick 5202 Granite Street—LUpeland CO 80537
LINSURERSERS
B: Pinnacol Assurance
,._Attn:
O_G
THE POLICIES OF INSURANCE LISTED 8ELOW HAVE SEEN ISSUED 1'0 THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING
ANY REQU1RENIENT, TERM OR CONDITION Or ANY CONTRACTOR OTHER
DOCUMENT WIl"H RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED SY TI IF. POLICIES DESCRIBED HEREIN
IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OP SUCH
POLICIES. AGGREGATE LIMITS SI'IOWN MAY HAVE BEEN (REDUCED BY PAID
CLAIMS,
LIT
NSR
W080FIN RANCE
POLICY NIJtABI'H
POLI �FFECTIVE
DATE M1tAfIDO/YY
PDAAYM 11 0 I N
DATE M1IM1IIDOMY
--"--'LIMITS
UTAITA
' --
GGNERpL LIAOILnY
A
X COMMERCIAL GENERAL LIABILITY
34UONTX0464
04/30/08
04/30 09
/
EACH OWUARENCC
roAWAcr.TonENNNRo '
$1,000 OOQ
—
�CINIAS MnUE XO OCCUR
PRCMISESHf Prcwomol
$300, 000
X Blanket Waiv(:r
MED EXP IAnYona
....� _ PU'•Pnl
$10,000
PERSONAL&ADV INJURY
--- —
_.
S1, QQQ ^QQQ
-
X Blanket Add'1 Ins'
`—"ITAPPLIES--
GCNLAGGREGATE LIMIT APPLIES PER
GENERAL AGGREOAI'E
""—'--^^--�--��-
62,000, DOC
-,..,,_,,,
POLICY PRO
.ISCT LOG
PRODUCTS"CON.ProP AGG.$
2,000, OOO
Em Ben.
1 0001000
pVTouomH.e ur.DLm
A
X ANY AVrO
34LTUNTX0464
04/30/OB
04/30/Q9
jrOnW:McnilNCLr LIMIT
)
$1,000,000
ALIOWNCOAUTOS
BODILYINJORY
(Fur Porsunl
S
SCHCOULEDAUTOS
A
X IIIIYEDAUTOS
IIODILYINJURY
(Pa sccbvn)
$
A
X NON-0N'NEDAVYCS
A
X Blanket Waiver
PRDpERttOAMAGE
Irv, Amaeml
$
On2n0E unBlutt
_-
ANYAUTO
AUTO ONLY - EA ACOOEA'L
$
OTHERTHAN EA ACC
_S
_
AUTO ONLY: ACV
S-..,-----
C %CG$$NIABRELI.p LIABILITY
._.
-"-
OCCUR CUIM1IS LMOE
A
E—"CH OCCURRENCE
5
'
AGGREGATE
$
"
OSDUC'IIBLE
_._ '---------.—_.__-__
RETENTION $
WORKCIRS COMPENSATION AND
B
EMPLOY
EfAPLOYEIiS'LIABILIIY
X TO�MIYS ER"
ANY PRO➢RIETOR/PARTNERIEXECUTIVE
OFFICERIM11MBER EXCLUDED?
4038253
07/01/08
07/01/09
EL EACH ACCIDENT
_ _
It Nos, UasuiOe vMer
SPECIAL PROVISIONS oelax
C_L, DISEASE- CA EAIPI EY
S 1, 000_ 000
OTt1ER
Il
St DISEASE -POLICY LIkIi
_
$1 QQQ QQQ
OI?SCRIPTION OF OPERATIONS / LODhitONS/ VEHICLES J EXCLUSIGNS AOOEp 8Y ENDORS:AIENrI SPECIAL PROVISIONS u-
All Operations - All Locations The Certificate Holder is Listed as
Additional Insured in regard to the General Liability, 221-6707
CERTIFICATE HOLDER .........� .._._.. ..
City of Ft. Collins
Purchasing Dept.
Attn: Kristine
P.O. Box 580
Fort Collins CO 80524
FTCOLLI I SHOULD ANY DP THE ABOVE DESCRIBED POLICIES BE CANCELLED 8EFORE THE EXPIWVIO
DATE THEREOF, THE ISSUING INSURER WILT. ENDEAVOR TO MAII, 10 OAYS YIRITTBN
NOTICE TO lH E CERTIFICATE ROLOCR NAMED TO THE LEFT, BUT FAILURE TO 00 SO SHALL
IMPOSE NOODUGATION OR UAOILITY OF ANY RIND UPON RIE INSURER, ITS AGENTS OR
ACORD, CERTIFICATE OF LIABILITY INSURANCE r.'R°Tc 1 DATE
04/28/08)
PRODUCER THIS CERTIFICATE 13 ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
LBN Insurance Agency HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
4848 Thompson Pkwy ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Johnstown CO 80534
Phone: 970-635-9400 Pax: 970-635^9401 INSURERS AFFORDING COVERAGE NAIC9
Portor Industries, Inc. INSURER C:
Attn: Cheryl Kendrick
5202 GraniLa Street INSURER D:
Loveland CO 80537 ---
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR TI1E POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY RCOUIRCMENI', TERM OR CONDITION OF ANY CONTRACT UR 01HER DOCUNEW WITH RESPECT'TO WVIICH.l HIS CERTIFICATE ,IIAY OE ISSUCO Olt
MAY PERTAIN. THE INSURANCE AFFORDEO OY THG POLICIES OESCRIBEO HEREIN IS SUBJECT TO ALi. THE TERMS, EXCLUSIONS AND CONDITIONS OF SVGA
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVC DECN REDUCED BY PAID CLAIMS.
INS
W1
PDATEYMMIDDIYY
LTR
NSR_
TYPEOFINSURANCE
POLICY LIUMOCR
DATEE M'fN Y)
LIMITS
GE•NRRAL LIABILITY
EACH OCCURRENCE
S1., 000, 000
A
X_ OONMCROIA GI-N[RAI IInJNNY
34UUNTX0464
04/30/08
04/30/09
OAPI T"IRITM—
PREMISES(E acc rence)
-
£ 300,000
,CLAIMS MADE (OCCUR
MED EXP(Any ono porso,,)
$10, 000
X Blanket Waiver
PERSONAL CADVINJURY
$1, 000, 000
GENERAL AGGREGATE
s2, 000, 000
X Blanket Add 1 Ins
GCN'I. AGGREGATE LIMR`APPLICS PER:
PRCOLON S-COMP/OPAGG
$2,000TOOO
_. PRO. (.
POLICY IX I JRCT I 1 LOG
.....__.. _... .___
ranp Ben.
. ....,.,..,.
1, 000,000
AUTOMOSR.E
LIABILITY
COMBINED SINGLELIMIT
$1,000,000
A
X
ANYAUTO
34UUNTX0464
04/30/08
04/30/09
IEe eamen0
ROOIIY INJURY
&
ALL OWNED AUTOS
SCBCOULEO AN I"OS
(Per poreon)
A
X
IIIREO AUTOS
BODILY INJURY
S
A
X
NON -OWNED AN TOS
(PcrnCNtlonl)
A
X
Blanket Waiver
PItOPCRIY DAMAGE
(Pcl auMoni)
GARAGE LIABILITY
I
AUTO ONLY -EA ACCIDENT
$
DTRRR TITAN _ FA AC,C
£
ANY AUTO
v
��. _
$
AUi'O ONLY: AGO
F,%ClESSIUMBREI,LA LIABILITY
EACH OCCURRENCE
$
J OCCUR El CLAIMS MADE
AGGREGATE
£
— DEDUCTIBLE�
�—
RE1 CIA ION S
WORKERS COMPENSATION AND
X TORY UfAITS ER
�v
B
EMPLOYERS LIABILITY
4038253
07/01/08
07/01/09
E.L. FACIA ACCIDENT
'_"'_
s1,, 000 000
ANYPROPRtETCRI
--
OFFICERIMEMS[flF.%CLIIOEp]
EXCLUDED?
E.L.CA EMPLOYEE
E.I. DISCASE - [A ENPLOYCC
$1, GOO, OOO
II " PROVISIONS
BPEDIAL PROVISIONS U.I.
I
_ __._..,._......__._.._____
E.L. DISTAFF,. POLICY LIMIT
$.11.,80-0 1Qg0
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
All operations - All Locations
CERTIFICATE HOLDER CANCELLATION
CITYXT3
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURF.RWILL ENDEAVOR TO MAIL 10 DAYSWRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO 00 SO SHALL
City Of Pt Collins YAC
IMPOSE NO OBLIGATION OR LIABILITY OF ANY RIND UPON THE INSURER, ITS AGENTS OR
P.O. BOX 580
REPRESENTATIVES.
ALIT ' E RESE 'ATIV. �
Pt. Collins, CO 80524
ACORD 25 (2001108) V AGUKU COKPUKA! IUN TUBB