HomeMy WebLinkAboutFREDERICK LAND SURVEYING - INSURANCE CERTIFICATEACQ80 CERTIFICATE OF LIABILITY INSURANCE OPID BA DATE (MMIDD/YYYY)
1
FREDE-1 07 O8 08
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIOIN
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
INSURERA: Hartford Insurance Coaga pies
INSURERS: Pinnacol Assurance
INSURER C:
Frederick Land Surveying Inc
6853 N Franklin Ave.
Loveland CO 80538
INSURER D:
----"-----"'-------
INSURER E'.
COVERAGES
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`
LTR
UD'
NSW
TYPE OF INSURANCE
POLICY NUMBER
POLIOV EiFECTIVE
DATE MMIDO/YY
POLICY EXPIRATION
DATE MMIDOIYY
LIMITS
GENERALLIABILITY
EACH OCCURRENCE
$ 1000000
A
X COMMERCIAL GENERAL LIABILITY
34SBAGK4906-CANCEL
D09/01/07
05/01/08
DAMAGE70 RENTED -_--
PREMISES (Ea ocwrence)_
$300000
CLAIMS MADE X OCCUR
MED EXP(Any one person)
$ 10000
X Contractual
PERSONAL B ADV INJURY
$1000000
X
Broad Form PD
GENERAL AGGREGATE
$ 2000000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMPIOP ADD
_
s2000000
-1
POLICY X PRO-
ECT OC
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
$ 1000000
X
ANY AUTO
34UECEZ4560-CANCEL
D09/01/07
05/01/08
(Ea accirieop
BODILY INJURY
ALL OWNED AUTOS
SCHEDULED AUTOS
(Per person)
$
X
HIREDAUTOS
BODILY INJURY
$
X
NON-OWNEDAUTOS
(Per aeeident)
PROPERTY DAMAGE
$
-
if
.--..--
-_
(Per accident)
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
ANY AUTO
OTHER THAN EA ACC
$
$
AUTO ONLY: AGG
EXCESS/UMBRELLA LIABILITY
EACH OCCURRENCE
S$1,000,000
A
X I OCCUR �CLAIMSMADE
34SBAGK4906-CANCEL
D09/01/07
05/01/08
AGGREGATE
$$1,000,000
S
$
DEDUCTIBLE
S
X RETENTION $10000
WORKERS COMPENSATION AND
X TORV LIMITS ER
B
EMPLOYERS' LIABILITY
CANCELLED
02/01/08
05/01/08
--"'-"------"--___---
E.LEACHACCIDENT
$1000000
EXECUTIVE
ANYPROPRIETORJPARTNEMEXECUTIVE--
_
E.L. DISEASE-EAEMPLOYE
-
$1DDDDOD
OFFICER/MEMBERIPARTNEBEREXCLUDED9
4039962
SPECIAL
SPECIAL PROVISIONSbelow
E. L. DISEASE -POLICY LIMIT
51000000
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS
All Locations / Surveying Operations/Insurance is Primary and
Non-Contributory/Certificate Holder is an additional insured as
their interest may appear with respect to work performed by the named
insured.
CERTIFICATE HOLDER CANCELLATION
CITYFTB SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATR
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 Ft. Collins IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
P.O. BOX 580 REPRESENTATIVES.
Fort Collins CO 80522 AUT I*,rfyRESErAtTI ,,,,
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.