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Home My WebLink AboutCLARK CONSTRUCTION - INSURANCE CERTIFICATEIMRTT F;"' IILI I ra J r" ACORD CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYVYI 03131/OS PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Flood & Peterson Insurance Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 4821 Wheaton Drive HOLDER THIS CERTIFICATE DOES NOT AMEND EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW P O Box 270370 Fort Collins CO 80527 INSURERS AFFORDING COVERAGE NAIC III INSURED INSURER A St Paul Travelers Insurance Company Clark Construction Co Inc INSURER B Pinnacol Assurance 2956 Ginnala Drive INSURER C Loveland CO 80538 INSURER D INSURER E GOVEKAGES 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 POLICY EFFECTIVE DATE IMM/DD/YY1 POLICY EXPIRATION DATE IM1WDD/YY1 LIMITS A GENERAL LIABILITY DTCO283P245ATIL05 03/01/05 03/01/06 EACH OCCURRENCE $1000000 OMMERCIAL GENERAL LIABILITY CLAIMS MADE F OCCUR PXCPD DAMAGE TO RENTED $300DDD MED EXP (Any one person) _ s5 DDD Ded2,500 PERSONAL & ADV INJURY $1000000 GENERAL AGGREGATE s2,000,000 GEN AGGREGATE LIMIT APPLIES PER PRODUCTS COMP/OP AGG s2,000,000 IL POLICY X JEOT El LOIS A AUTOMOBILE LIABILITY ANY AUTO DT810283P245ATIL05 03/01/05 03/01/06 COMBINED SINGLE LIMIT (Ea accident) $1 000 000 X BODILY ,per INJURY (Per person) S ALL OWNED AUTOS SCHEDULED AUTOS X HIRED AUTOS NON OWNED AUTOS BODILY accident) (Per accitlant) $ X PROPERTY DAMAGE (Peracatlent) S GARAGE LIABILITY AUTOONLV EAACCIDENT S OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY AGG A EXCESS/UMBRELLA LIABILITY AlOCCUR CLAIMS MADE DTSMCUP283P245ATIL 03/01/05 03/01/06 EACH OCCURRENCE $1000000 AGGREGATE S1,000,000 S DEDUCTIBLE X RETENTION $10000 $ B WORKERS COMPENSATION AND 4000003 04/01/0S 04/01/06 X WCSTATU OTH t r EMPLOYERS LIABILITY E L EACH ACCIDENT $500 000 ANY PROPRIETOR/PARTNEWEXECUTIVE DISEASE EA EMPLOYE $SOO OOO OFFICER/MEMBER EXCLUDED'EL If yes descnbe untler E L DISEASE POLICY LIMIT 1 s500 000 SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS ATTN John Stephen FAX 221 6707 RE Fossil Creek Park The City of Fort Collins is named as additional insured Excluding Workers Compensation) City of Fort Collins Purchasing Dept 215 N Mason Fort Collins CO 80524 LO ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION THEREOF THE ISSUING INSURER WILL ENDEAVOR TO MAIL _-11) DAYS WRITTEN E TO THE CERTIFICATE HOLDER NAMED TO THE LEFT BUT FAILURE TO DO SO SHALL IE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR ETpJUICVM3 . .., .. rrwrvv r c, rrro 1 vvvo Nib V AI.vKU LlVKHVKA I ION T B88 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 ^- <11 Z oT Z 8531 uti93/M370605