HomeMy WebLinkAbout103009 PORTER INDUSTRIES INC - INSURANCE CERTIFICATE (12)ACORD. CERTIFICATE OF LIABILITY INSURANCE OP ID RC DATE IMMIDDNYYY)
PORTE-1 1 06 16 08
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#
INSURED INSURER A: The Hartford
INSURER B. Plnnacol Assurance
Porter Industries, Inc. ----_._ _._..._. _. ____ __.._.__--.._
Attn: Cheryl Kendrick INSURER0.
5202 Grani a Street INSURER D:
Loveland CO 60537
INSURER E:
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 1$ SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSOIT—— — __ _._.. ___.. ..
POLICYEFFECTIVE POLICYEXPIRATION
LTR NSft TYPE OF INSURANCE POLICY NUMBER DATE MM/DDM DATE MMIDD/YY LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$1,000,000
A
X COMMERCIAL GENERAL LIABILITY
34UUNTX0464
04/30/08
04/30/09
DAMAGETO RENTS
PREMISES (Eaoccorence)
-- --'--
$300,000
CLAIMS MADE EX] OCCUR
MED EXP (Any one person)
$ 10, 000
X Blanket Waiver
PERSONAL BADVINJURY
$1,000,000
X
Blanket Add' 1 Ins
GFNERAL AGGREGATE
s2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGO
$2,000,000
POLICY X jECT LOC
Ben.
1,000,000
AUTOMOBILE
LIABILITY
A
COMBINED SINGLE LIMIT
$1,000,000
X
ANY AUTO
34UUNTX0464
04/30/08
04/30/09
(Ea acatlenQ
_- --_-
ALL OWNED AUTOS-�_-�--
--
BODILY INJURY
$
SCHEDULED AUTOS
(Per person)
A
X
HIREDAUTOS
BODILY INJURY
$
A
X
NON -OWNED AUTOS
(Par accident)
A
Blanket Waiver
X
PROPERTY DAMAGE
$
(Per accident)
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
ANV TO
OTHER THAN _EA ACC
$
_
$
AUTO ONLY: AGO
EXCESS/UMBRELLA LIABILITY
EACH OCCURRENCE
$
OCCUR � CLAIMS MADE
AGGREGATE
$
DEDUCTIBLE
RETENTION $
$
WORKERS COMPENSATION AND
X TORY LIMITS ER
B
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
g038253
07Ol 08
/ /
07/01/09
E.L. EACH ACCIDENT
$1, 000,000
OFFICERIMEMBER EXCLUDED?
E.L. DISEASE - EA EMPLOYEE
$ 1 , 000 , OO Q
It yes, aescrioe una I
—
E.L. DISEASE-FOLICYLIMJT
-.._._-
$i QQQ QQQ
SPECIAL PROVISIONS below
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
All Operations - All Locations
City of Ft. Collins
Utilities Department
Attn: Steve Bohnam
700 Wood Street, Building A
Fort Collins CO 80521-0580
FTCOLLI 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.
25 (2001108)
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 bebr✓een
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.
25