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Home My WebLink About132158 CTL/THOMPSON INC - INSURANCE CERTIFICATE (9)ACORDa CERTIFICATE OF LIABILITY INSURANCE 0912;;04°" PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Van Gilder Insurance Corp ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 700 BroadwaySuite 1000 HOLDER THIS CERTIFICATE DOES NOT AMEND EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW Denver CO 80203 303 837 8500 INSURERS AFFORDING COVERAGE INSURED INSURER A Hartford Insurance Group CTL/Thompson Inc INSURERS Pinnacol Assurance 7306 S Alton Way I INSURER C Lexington Insurance Company (AIG) Centennial CO 80112 INSURER 0 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 TR rypE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE I DATEM D POLICYEXPIRATION LIMITS A GENERAL LIAuILTI 31 Ui EX2V�V 19^1911Lr /� I1C1041145 �M1('4 rn �77a-IC� 11000000 FIRE DAMAGE (Anyone fire)_ $300000 OMMERCIALGENERALLIABILITY CLAIMS MADE OCCUR #XPID MED EXP(My one person) $10000 PERSONAL &ADV INJURY $1 000 000 Ded 1,000 GENERALAGGREGATE _ s2,000,000 GEN L AGGREGATE LIM ITAPPLIES PER PRODUCTS COMP/OPAGG _ $2000000-1 7 POLICY PRO LOC _ A AUTOMOBILE X LIABILITY ANY AUTO 34UENTZ9366 10/01/04 10/01/05 COMBINED SINGLE LIMIT (Ea accident) $1000000 BODILY INJURY P. pareon) $ ALL OWNED AUTOS SCHEDULED AUTOS X X HIREDAUTOS INON OWNED AUTOS BODILY INJURY (Per accident) $ X Drive Other Car PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTOONLY EAACCIDENT $ OEAACC AN $ ANY AUTO $ AUUTOTO ONLY qGG A EXCESS LIABILITY X OCCUR CLAIMS MADE 34XHUEX1980 10/01/04 10/01/05 EACH OCCURRENCE $6000000 $6 O00 000 AGGREGATE S _ DEDUCTIBLE $ X RETENTION $10000 $ B WORKERS COMPENSATION AND 618052 10/01/04 110/01/05 X WCSTATU OTH IMP 0 FRS L-A" ITY L U GHIAUl 11,J 1 $500 000 E L DISEASE EA EMPLOYEE $500 000 E L DISEASE POLICY LIMIT $500 000 C OTHER Architects & 5397819 11/22/03 11/22/04 $2 000 000 per claim nglneers $4 000 000 annl aggr rofessional Liab DESCRIPTION OF OPERILTIONWLOCATIONSIVEHICLEW/ CLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS City of Ft Collins Purchasing Division is listed as an Additional Insured under General Liability only in respects to their interest In work performed by the insured as per written specified contracts City of Ft Collins Purchasing Division P O Box 580 Fort Collins CO 80522 SHOULD ANYOF TH E ABOVE D ESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF THE ISSUING INSURER WILL ENDEAVOR TO MAIL-0 DAYSWRrITEN NOTICE TO THE CERTIFICATE HOLD ER NAM ED TOTH E LEFT BUT FAILURE TO D 080 SH ALL IM POSE NO OB LIGATION OR LIAB ILITY OF ANY KIND UPON TH E INSURER ITS AGENTS OR REPRESENTATIVE ACORD 25 S (7/97)1 of 1 NM379203 MnrL 0 ACORn CORPORATION EFFECTIVE DATE 12 01 AM Standard Time (at your principal place of business) BUSINESSOWNERS PS AI 07 (01 01) ACKNOWLEDGEMENT OF ADDITIONAL INSURED STATUS STATE OR POLITICAL SUBDIVISIONS - PERMITS RELATING TO PREMISES Person or Organization Designated as an Additional Insured CITY OF FT COLLINS ATTN JOHN STEPHEN P O BOX 580 FT COLLINS CO 80521 Designated Premises 223 SOUTH HOWES STREET FORT COLLINS CO 805210000 This form has been sent to you to acknowledge your status as an additional insured under our meaning the is suing Company stated below insurance policy issued to the Named Insured shown below Under our Premier Businessowners Liability Coverage Form Section II WHO IS AN INSURED provides as fol lows Any of the following persons or organizations are automatically insureds when you [i a the Named Insured stated below] and such person or organization have agreed in a written contract or agreement that such person or organization be added as an additional insured on your policy providing general liability coverage State or Political Subdivisions Permits Relating to Premises Any state or political subdivision which has issued a permit in connection with premises insured by this Policy which you own rent or control is an additional insured but only with respect to the following hazards 1) The existence maintenance repair construction erection or removal of advertising signs awnings canopies cellar entrances coal holes driveways manholes marquees hoistaway openings sidewalk vaults street banners or decoration and similar exposures 2) The construction erection or removal of elevators or 3) The ownership maintenance or use of any elevators covered by this insurance HOWEVER such state or political subdivision s status as additional insured under this policy ends when the permit ends The policy language set forth above is subject to all of the terms and conditions of the policy issued to the Named Insured shown below For your information our Named Insured the Policy Number Policy Term and Limits of Insurance are stated below Named Insured CANNON, SUSIE, KORTH, LAUNIE AS A PARTNERSHIP ENTITY ONLY DBA Issuing Company AMCO INSURANCE COMPANY Policy Number ACP BPS 7570068542 Policy Term 10.15-04 To 10.15-05 Limits of Insurance Per Occurrence $1 000000 All Occurrences $2,000,000 PB Al 07 (01 01) ACP BPS 75700BOS42 ADDL INSRD COPY 75 39"