HomeMy WebLinkAboutCNI CONTRACTORS - INSURANCE CERTIFICATE (2)Client#: 52117
8CNICONT
ACORDn. CERTIFICATE OF LIABILITY
INSURANCE
DATE P'M'D
04/29/08 Dnvvv)
PRODUCER
HRH of Colorado
720 South Colorado Boulevard
Suite 60ON
Denver, CO 8024E
THIS CERTIFICATE- IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
NAIC #
INSURED
CNI Contractors, Inc.
1207 South Lipan St.
Denver, CO 00223
INSURER A: Mountain States Insurance_ Group
5900
INSURER a: Employers Compensation Insurance Co.
11512
INSURER c: Fireman's Fund Insurance Company
21873
INSURER D:
_
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED T'O THE INSURED NAMED ABOVE FOR 1'1IE 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, TPIE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT 70 ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SI10WN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
M1
NSR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE flMMIDDIYYI
POLICY EXPIRATION
DATE IMMIDUNY1
LIMITS
A
GENERAL LIABILITY
CPP0105277
05/01/08
05/01/09
EACH OCCURRENCE
S1 o00 0O0
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE F—x1 OCCUR
DAMAGE TO RENTED
,GE T oacunonco) _
$19E OOO
MED EXP (Anyone Pelson)
$1 O 000
PERSONAL & ADV INJURY
$1.000000
X PDDed:1,000
GENERAL AGGREGATE
S2 00O 000
GEN'L AGGREGATE
POLICY
LIMIT APPLIES PER:
X ,PIE T X LOG
PRODUCTS. COMPIOP AGG
s2u000,000_
Jobsite
Pollution
250,000
A
AUTOMOBILE
X
LIABILITY
ANY AUTO
BAP0105277
05/01/08
05/01/09
COMBINED SINGLE LIMIT
(EaHmidenl)
$�
1,669r000
BODILY INJURY
ALL OWNED AUTOS
SCHEDULED AUTOS
(Pet person)
X
X
BODILY INJURY
(Per accitlenl)
HIREDAUTOS
NONOWNED AUTOS
X
PROPERTY DAMAGE
(P waecitlem)
$
Drive Other Car
John/Susan Maus
ACV Ded. Applies
Ph sical Dama e
GAR AGE LIABILITY
AUTO ONLY -EA ACCIDENT
$
OTHER THAN FA ACC
AUTO ONLY: AGG
S
ANYAUTO
a
$
A
EXCESSIUMBRELLA LIABILITY
UMB0105277
05/01/08
05/01/09
EACH OCCURRENCE
s2,000,000
AGGREGATE
s2 OOO OOO
—XI OCCUR CLAIMS MADE
S
_
$
DEOUCTIBLE
$
X RETENTION $ 10 COO
B
WORKERS COMPENSATION AND
FN0329093
07/01/07
07/01/08
X1 ADSTArD on+
F.A.EACH ACCIDENT
SSOO,000
EMPLOYERS' LIABILITY
ANY PROPRIETORIPARTNEIVEXECUTIVF
OFRCERIMFMBER EXCLUDED?
_
E.L. DISEASE- EA EMPLOYEE
$500.000
SPECIAL PROVIS10NS bolow
E.L. DISEASE -POLICY LIMIT
$500000
C
OTHER Lease/Rent
_
MXI98473957 v
05/01/08
05/01/09
$450,000
Install Floater
Ded. Applies
$1,100,000 Jobsite
$100,000 Te_m Rransit
DESCRIPTION OF OPERATIONS I LOCATIONS I 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 THE 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
IS NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
1 of 3 #M5829114
8NPER o ACORD CORPORATION 1981
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 (2001/081 9 of 3 HMRR99Rd