HomeMy WebLinkAboutSINNETT BUILDERS - INSURANCE CERTIFICATE (2)ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID KH DATE(MM/DD/YYYY)
1
SINNE-1 06 03 08
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: EMC Insurance Companies
INSURERS: Plnnacol Assurance
Sinnett Builders Inc.
SB Construction LLC
IBP 14 Co
PO BOX 1969
Fort Collins CO 80522
INSURER C.
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 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.
LTR
NSR
TYPE OF INSURANCE
POLICY NUMBER
DATEYMMIDD/lYE
POLICY
MWDDMN
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$1,000,000
PREMISES(Eeoccurence)
$300,000
A
X COMMERCIAL GENERAL LIABILITY
3X23769
06/30/08
06/30/09
CLAIMS MADE FX] OCCUR
MED EXP (Any one person)
$ 5,000
PERSONAL S ADV INJURY
$ 1, 000, 000
X Banket Al
FORM CG7482
X
Blanket Waiver
FROMCG7555
GENERAL AGGREGATE
$2,000,000
GENT AGGREGATE LIMIT APPLIES PER.
PRODUCTS - COMP/OP AGG
$2,000,000
POLICY X JECT LOC
A
AUTOMOBILE
LIABILITY
ANY AUTO
3X23769
06/30/08
06/30/09
COMBINED SINGLE LIMIT
(Ea accident)
$1,000,000
X
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
X
BODILY INJURY
(Per ecutlent)
$
HIRED AUTOS
NON -OWNED AUTOS
X
PROPERTY DAMAGE
(Per awdent)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
$
AUTO ONLY: AGG
EXCESS/UMBRELLA LIABILITY
EACH OCCURRENCE
$ S 000 000
A
X OCCUR 7CLAIMSMADE
3X23769
06/30/08
06/30/09
AGGREGATE
$5,000,000
$
$
DEDUCTIBLE
$
X RETENTION $ 1O 000
1
B
WORKERS COMPENSATION AND
ANY PROPRIETOR/PAREMPLOYERS'LUIBILITYTNER/EXECUTIVE
4045474
07/01/08
07/01/09
X TORVLIM ITS I X I ER
E.L. EACH ACCIDENT
ESOO, 000
E, L. D ISEASE-EA EMPLOYEE
gSOO,000
O /MEMBER EXCLUDED9
If yes, describe under
yes, de
SPECIALPROVISIONSbelow
er_wlo:a vAtYr.R OF sUBPA
M.
-- "-
E.L, DISEASE -POLICY LIMIT
------- --'- - -
$50O 000
OTHER
A
Equipment
3X23769-06
06/30/08
06/30/09
Rented or $50,000
A
Builders Risk
3L23769-06
06/30/08
06/30/09
Leased $1000 ded
DESCRIPTION OF OPERATIONS / LOCATIONS [VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS
All Operations - All Locations. The Certificate Holder is listed as
Additional Insured in regard to the General Liability.
CERTIFICATE HOLDER CANCELLATION
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 SO SHALL
City of Fort Collins
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR
P.O. BOX 580
REPRESENTATIVES.
AUT pEyRESE ATIv• .
Ft. Collins CO 80522
ACORD 25 (2001108) 0 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.
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