HomeMy WebLinkAbout103009 PORTER INDUSTRIES INC - INSURANCE CERTIFICATE (10)ACORD,. CERTIFICATE OF LIABILITY INSURANCE OP ID RIC DATE(MM/DD/YYYY)
PORT E-1 06 16 O8
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
LBN Insurance Agency HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
4848 Thompson Pkwy ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Johnstown CO 80534
Phone:970-635-9400 Fax:970-635-9401 INSURERS AFFORDING COVERAGE NAIC#
Porter Industries, Inc.
Attn: Cheryl Kendrick
5202 Granite Street
Loveland CO 80537
C7ZHT/�:7_[H�9
INSURER A'. The Hartford
INSURERS.. Pinnacol Assurance
INSURER C.
INSURER D:
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.
1NSR
LTR
DD'
NSR
--'
TYPE OF INSURANCE
- _--
POLICY NUMBER
POLICY EFFECTIVE
DATE MMIDD/YY
POLICY EXPIRATION
DATE MM/DDM'
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$ 1 , OOO , OOO
A
X COMMERCIAL GENERAL LIABILITY
34UUNTX0464
04/30/08
04/30/09
DAMAGETO ENTED PREMISES (Ea occurence)
'"'-'-'—
$3DD,00D
CLAIMS MADE NJOCCUR
MED EXP (Any one person)
$ 10 , 000
PERSONAL & ADV INJURY
$1,000,000
X Blanket Waiver
X
Blanket AddIl Ins
GENERAL AGGREGATE
$2,000,000
GEN'LAGGREGATE LIMITAPPLIES PER:
PRODUCTS - COMP/OP AGG
$2,000,000
POLICY X PROECT 17 LOC
J
Emp Ben.
1,000,000
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
$1 OOO OOO
X
A
ANY AUTO
34UUNTX0464
04/30/08
04/30/09
(Ea accident)
BODILY INJURY
ALL OWNED AUTOS
SCHEDULED AUTOS
(Per person)
$
X
BODILY INJURY
A
HIRED AUTOS
X
A
NON -OWNED AUTOS
(Per accident)
$
A
XBlanket
Waiver____
PROPERTY DAMAGE
(Per accident)
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
$
AUTO ONLY: ASS
EXCESS/UMBRELLA LIABILITY
EACH OCCURRENCE
$
OCCUR CLAIMS MADE
AGGREGATE
$
IS
$
DEDUCTIBLE
$
RETENTION $
WORKERS COMPENSATION AND
WC STATU-
X TORV LIMITS ER
B
EMPLOYERS' LIABILITY
4038253
07/01/08
07/01/09
- -
E.LEACH ACCIDENT
$1,000,000
ANY PROPRIETOR/PART NER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
E.L. DISEASE - EA EMPLOYEE
$1,000,000
If yes, daacribe under
.-......._._._______....._.___...._
__..._.____
SPECIAL PROVISIONS below
E.L. DISEASE -POLICY LIMIT
$1,000,000
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
All Operations - All Locations The Certificate Holder is listed as
Additional Insured in regard to the General Liability. 221-6707
CERTIFICATE HOLDER CANCELLATION
City of Ft. Collins
Purchasing Dept.
Attn: Kristine
P.O. Box 580
Fort Collins CO 80524
FTCOLLI I 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
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
ACORD 25 (2001/081
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.
(2001/08)