HomeMy WebLinkAboutSINNETT BUILDERS - INSURANCE CERTIFICATE (3)-CORD- CERTIFICATE OF LIABILITY INSURANCE OPID KB DATE (MM DDP YYY)
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
LDER HIS CERTIFICATE DOES NOT AMEND EXTEND484 Thoompon wyALTER THE COVERAGE AFFORDED BY THE POLICIES
Johnstown CO 80534
Phone 970-635-9400 Fax 970-635-9401 INSURERS AFFORDING COVERAGE NAIC#
INSURER EMC Insurance Companies
Sinnett Builders Inc INSURER B Pinnacol Assurance
SB Construction LLC
IBP 14 Corp INSURER C
PO Box 1969 INSURER D
Fort Collins CO 80522
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
INUKLTR
NSR
TYPE OF INSURANCE
POLICY NUMBER
DATE IWDD/YEFFECTIVE
PDATE MMIDDm
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$1,000,000
A
R
R COMMERCIAL GENERAL LIABILITY
3R23769
06/30/OB
06/30/09
PREMISES(Eeo=renoe)
s300,000
CLAIMS MADE ® OCCUR
MED EXP (Any one person)
$ 5,000
R Banket Al
FORM CG7482
PERSONAL S ADV INJURY
$1,000,000
R
Blanket Waiver
FROMCG7555
GENERAL AGGREGATE
$2,000,000
GEN L AGGREGATE LIMIT APPLIES PER
PRODUCTS COMP/OP AGG
E2,000,000
POLICY R JECOT LOC
AUTOMOBILE
LIABILITY
ANY AUTO
3R23769
06/30/08
06/30/09
COMBIA
(EaaW ent)ED LE LIMIT
$ 1 QQQ QQQ
R
ALL OWNED AUTOS
BODILY INJURY
$
SCHEDULED AUTOS
(Per person)
R
HIRED AUTOS
NON OWNED AUTOS
BODILY INJURY
(Perawdenl)
$
R
PROPERTY DAMAGE
$
(Per accident)
GA RAGE LIABILITY
AUTOONLV EAACCIDENT
$
ANYAUTO
OTHER THAN EA ACC
E
$
AUTO ONLY AGO
EXCESS/UMBRELLA LIABILITY
EACH OCCURRENCE
$5 000, 000
A
R OCCUR �CLAIMSMADE
3R23769
06/30/08
06/30/09
AGGREGATE
$5,000,000
E
DEDUCTIBLE
E
R RETENTION $10000
$
WORKERS COMPENSATION AND
R TORY LIMITS R ER
E
EMPLOYERS LIABILITY
PROPRIETOR/PARTNER/EXECUTIVE
4045474
07/01/08
07/01/09
EL EACHACCIDENT
$ 500,000
OFFIANY
Ifyes dRIMEMSnd EXCWOED4
yes ALPROeambe
awrw.T A1Y a of aVeawN
CL DISEASE EAENP OYCC
$ 500,000
EL DISEASE POLICY LIMIT
$ 50Q QQQ
S
SPECIAL PROVISIONS Detow
PROVISIONS
OTHER
A Equipment 3R23769-06 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 I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
Project General Contractor for Fire Station Expansion P-872
Fire Station
City of Fort Collins and Poudre Fire Authority are named as additional
insureds with respects to the general liability
CITYFOR 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 80 SHALL
City Of Fort Collins IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR
300 LaPorte Ave REPRESENTATIVES
Fort Collins CO 80522 AUT IW AEVRESEWk1f1VJj
ACORD 25
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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