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HomeMy WebLinkAboutCLARK ENTERPRISES - INSURANCE CERTIFICATE (2)ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID D DATE (MM/DDM YY) PRODUCER CLARK-4 01/13/05 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION LSN Insurance Agency, LLC PC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES T AMEND EXTEND OR 1614 Oakridge Drive, Unit A ALTER THE COVERAGE AFFORDED BY O HE POLICIES BELOW Fort Collins CO 80525 Phone 970-229-9304 Fax 970-229-1398 INSURERS AFFORDING COVERAGE INSURED NAIC # INSURER A M. t state in a an a Gzp Clark Enterprises Construction INSURERB CO ry INSURERC EatoneCO B0615 NSURER D COVERAGES INSURER E THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDIN G ANY REQUIREMENT TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE N1AV BE ISSUED OR MAY PERTAIN THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS EXCLUSIONS AND POLICIES AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS CONDITIONS OF SUCH LTR NSR TYPE OF INSURANCE GENERAL LIABILITY POLICYNUMBER DATE MM/DD/YY DATE MMIDD/YY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS MADE F7 OCCUR CPP0103409 01/13/05 01/13/06 EACH OCCURRENCE $1,000,0QQ PREMISES(Eaoccurence) $100,000 MED EXP (Any one person) $ 10 000 PERSONALBADV INJURY $1, 000 QQQ GEN L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $2, 000 000 PRODUCTS COMP/OP AGG $2,000 000 PRO POLIGV X JECT LOC AUTOMOBILE LIABILITY A ANY AUTO ALL OWNED AUTOS BAP0103409 Ql/13/Q5 O1/13/06 COMBINED SINGLE LIMIT (Eaat<menp $1 000 000,000 X BODILY INJURY (Per person) $ SCHEDULED AUTOS X HIRED AUTOS X BODILY INJURY (Per accident) $ NON OWNED AUTOS PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO AUTO ONLY EAACCIDENT $ OTHER THAN EA ACC AUTO ONLY AGG $ EXCESS/UMBRELLA LIABILITY $ A X OCCUR [�ICLAIMSMADE UMB0103409 01/13/05 01/13/06 EACH OCCURRENCE $ 1,000,000 AGGREGATE $1,000 QQQ DEDUCTIBLE X RETENTION $lO QQQ WORKERS COMPENSATION AND EMPLOYERS LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDEDo I TORY LIMITS ER EL EACH ACCIDENT $ E L DISEASE EA EMPLOYEE $ If yes desmbe under SPECIAL PROVISIONS below E L DISEASE POLICY LIMIT S OTHER A Rented/Leased Equi CPP0103409 01/13/05 O1/13/06 150,000 A builders risk CPP0103409 O1/13/05 O1/13/06 400,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS CERTIFICATE HOLDER CITYFTC 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 215 North Mason REPRESENTATIVES Fort Collins CO 80525 AU RIZ REPRES ACORD 25 (2001108) J © ACORD CORPORATION 1988 �ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID D DATE(MM/DDYYYY) CLARX-4 01/13/05 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE LBN Insurance Agency, LLC FC HOLDER THIS CERTIFICATE DOES NOT AMEND EXTEND OR 1614 Oakridge Drive, Unit A ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW Fort Collins CO 80525 Phone 970-229-9304 Fax 970-229-1398 INSURERS AFFORDING COVERAGE NAIC# INSURER Mou to n at t.. Insurance INSURERS Clark Enterprises Construction Co WSURERC 80 Factory Rd INSURER Eaton CO B0615 .em�acra��a THE POLICIES OF INSURANCE LISTED BELOW RAVE 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 Mail LTRINSRE RIJU TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM/DO/YY POLICY EXPIRATION DATE MM/DD/W LIMITS A GENERAL LIABILITY X: COMMERCIAL GENERAL LIABILITY CLAIMS MADE X� OCCUR CPP0103409 01/13/05 01/13/06 EACH OCCURRENCE s1,000,000 -DAWPOGE-T EN PREMISES (Ea occurence) $100,000 VIED EXP (Any one person) $ 10,000 PERSONAL B ADV INJURY s1 000,000 GENERAL AGGREGATE s2,000 000 GEN L AGGREGATE LIMIT APPLIES PER 17 POLICY X PROJECT F7 LOC PRODUCTS COMP/OP AGG $2,000,000 A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON OWNED AUTOS BAP0103409 01/13/05 01/13/06 CO BIKED (EeCOMBINED SINGLE LIMIT $1 DOD , ,ODD X BODILY INJURY (Per parson) $ X BODILY INJURY (Per accident) $ X PROPERTY DAMAGE (Pet accident) $ GARAGE LIABILITY ANY AUTO AUTOONLV EAACCIDENT $ OTHER THAN EA ACC AUTO ONLY AGO $ $ A EXCESSIUMBRELLALIABILITY X OCCUR CLAIMSMADE DEDUCTIBLE X RETENTION $10000 UMB0103409 01/13/05 01/13/06 EACH OCCURRENCE It1,000,000 AGGREGATE $1,000 000 $ $ WORKERS COMPENSATION AND EMPLOYERS LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERMIEMBER EXCLUDED? If yes descr be under SPECIAL PROVISIONS below TO11�RV LIMITS ER E L EACH ACCIDENT $ E L DISEASE EA EMPLOYEE $ E L DISEASE POLICY LIMIT $ A A OTHER Rented/Leased Equi builders risk CPP0103409 ICPP0103409 01/13/05 01/13/05 01/13/06 01/13/06 150,000 1 400,000 DESCRIPTION OF OPERATIONS / LOCATIONS VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS ALL OPERATIONS/ALL LOCATIONS FORT CO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATETHEREOF THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT BUT FAILURE TO 00 SO SHALL CITY OF FORT COLLINS IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR 281 N NORTH COLLEGE REPRESENTATIVES FORT COLLINS CO 80522 AU RU: REPRES \ G ACORD 25 (2001/081