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HomeMy WebLinkAbout345637 C & R ELECTRICAL CONTRACTORS - INSURANCE CERTIFICATE (2)ACORDM CERTIFICATE OF LIABILITY INSURANCE iz121/z a' PRODUCER (303) 756-9909 FAX (303) 756-8818 Keller -Lowry Insurance Inc 1777 S Harrison St #700 Denver, CO 80210 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 C & R Electrical Contractors, Inc. P.O. Box 33448 Northglenn, CO 80233 INSURERA: Allied Group/Nationwide Mutual INSURER B: INSURER C: NSURER D: NSURER 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. INSR ADD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MMUDDIYYI POLICY EXPIRATION DAM MMIDDLYYI LIMITS GENERAL LIABILITY ACP7521106606 07/01/2004 07/01/2005 EACH OCCURRENCE $ 1,000,00 DAMAGE TO RENTED $ 100,000 X COMMERCIAL GENERAL LIABILITY CLAIMS MADE OOCCUR $ 5,00 MED EXP(Any one person) PERSONAL SADVINJURY $ 1,000,00 A GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $ 2,000,00 X POLICY PRO- LOC JECT AUTOMOBILE LIABILITY ANYAUTO ACP7521106606 07/01/2004 07/01/2005 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,00 X BODILY INJURY (Per person) $ A ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS X BODILYaccident) (Per accitlent) $ X PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGO $ EXCESSIUMBRELLA LIABILITY X OCCUR CLAIMS MADE ACP7521106606 07/01/2004 07/01/2005 EACH OCCURRENCE $ 1,000,00 AGGREGATE $ 1,000,000 A $ DEDUCTIBLE $ $ RETENTION $ WORKERS COMPENSATION AND WC STATU- DTH- EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under E.L.DISEASE- EA EMPLOYE - -- $ E.L. DISEASE -POLICY LIMIT - $ SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Project: Tennis Court Lighting at City Park Certificate Holder is named as an Additional Insured under the General Liability ONLY with respects to he above referenced project. Except for 10 Days Notice for Non -Payment of Premium City of Fort Collins Attn: John Stephen P.O. Box 580 Fort Collins, CO 80522 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL *30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE D.J.....a C:L..T i.... �T fir I rA AVUKU ZD JZUUIIUtf) ©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. ACORD 25 (2001108) ACORD CERTIFICATE OF LIABILITY INSURANCE CSR DP DA .E (MM/DD/YYYY)� THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Compass Insurance Agency, Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Olson & Olson Division HOLDER THIS CERTIFICATE DOES NOT AMEND EXTEND OR P 0 Box 1467 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW Englewood CO 80150 Phone 303-761-0085 Fax 303-788-1817 INSURERS AFFORDING COVERAGE NAIC # NSURED INSURER pinnacol Assurance INSURERS C & R Electrical Contractors INSURER P O Box 33448 INSURER Northglenn, CO 80233 _ INSURER E THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REOUIREMENT 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 DATE MM/DD/YY DATE MM/DD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY $ CLAIMS MADE EOCCUR PREMISES (Ea ocarence) MED EXP (Any one parson) $ PERSONAL $ ADV INJURY $ GENERAL AGGREGATE $ GEN L AGGREGATE LIMIT APPLIES PER PRODUCTS COMP/OPAGG $ POLICY JECT 7 LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILYINJURY $ SCHEDULED AUTOS (Perrperson) HIRED AUTOS BODILY INJURY $ NON OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTOONLV EAACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY AGO $ EXCESS/UMBRELLA LIABILITY ^OCCUR EACH OCCURRENCE $ Ll CLAIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION $ $ WORKERS COMPENSATION AND X I I EMPLOYERS LIABILITY TORV LIMITS ER A ANY PROPRIETOWPARTNER/EXECUTIVE 4058262 07 /01/04 07/01/05 EL FACH ACCIDENT $ 100000 OFFICERIMEMBER EXCLUDED' OWNERS INCLUDED E L DISEASE EA EMPLOYEE $ 100000 If yes describe ntler SPECIAL PROVISIONS below EL DISEASE POLICY LIMIT $500000 OTHER EXCEPT FOR 10 DAYS FOR NONPAYMENT OF PREMI DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Waiver of Subrogation applies in favor of the City of Fort Collins rcurllci r--- CYFTCOL SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATETHEREOF THE ISSUING INSURER WILL ENDEAVOR TO MAIL *30 DAYSWRITTEN City of Ft Collins NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT BUT FAILURE TO DO SO SHALL Attn John Stephen P 0 BOX 580 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR Fort Collins CO 80522 REPRESENTATIVES 25 (2001108) ©ACORD