HomeMy WebLinkAboutCOLORADO BORING - INSURANCE CERTIFICATE (2)CORD CERTIFICATE OF LIABILITY INSURANCE OP �D P6 DATE (MM/OD/YWY)
!Brown & Brown Inc
125 S Howes 5th Floor
P O Box 2226
Fort Collins CO 80522-2226
Phone 970-482-7747 Fax 970-484-4165
Colorado Boring LLC
Jacobs Investment LLC dba
812 Queen Ct
Fort Collins CO 80524
1HI5 CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER THIS CERTIFICATE DOES NOT AMEND EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW
INSURERS AFFORDING COVERAGE NAIC #
INSURERA Mountain States Mutual_ 14648
INSURER Pinnacol Assurance 41190
INSURER C
INSURER D
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 IS SUBJECT TO ALL THE TERMS EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
LTR
NSR
TYPE OF INSURANCE
POLICY NUMBER
P LICY F E TIVE
DATE MM/DD/YY
P Y E%PIRA
DATE MM/DD/YY
-
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$ 1 000 000
A
X COAVERCIALGENERAI (ABILITY
CPP010170305
08/01/08
08/01/09
PREMISES (Eaaccurence)
$100 000
CLAIMS MADE )�] OCCUR
MED EXP(Any one person)
$ 10 000
PERSONAL& ADV INJURY
$ 1 000 000
INCLUDES BuemaT WAIVER
GENERAL AGGREGATE
$ 2 000 000
OF SUBROGATION
GEN L AGGREGATE LIMIT APPLIES PER
PRODUCTS COMP/OP AGG
$2 000 000
POLICY X JECT LOC
AUTOMOBILE
LIABILITY
A
X
ANY AUTO
BAP010170305
08/01/08
08/01/09
COMBINED SINGLE I IMIT
(Ea accident)
$ 1 000 000
ALL OWNED AUTOS
BODILY INJURY
SCHEDULED AUTOS
(Par person)
HIRED AUTOS
X
BODILY INJURY
$
X
NON OWNED AUTOS
(Per accident)
PROPERTY DAMAGE
$
(Per accident)
GARAGE LIABILITY
AUTOONLY EAACCIDENT
$
ANY AUTO
OTHER THAN EA ACC
$
AUTO ONLY AGG
$
EXCESSIUMBRELLA LIABILITY
EACH OCCURRENCE
$ 5 000 000
A
X OCCUR CLAIMSMADE
UMB010170305
08/01/08
08/01/09
AGGREGATE
$ 5 000 000
DEDUCTIBLE
$
X RETENTION $10 000
$
WORKERS COMPENSATION AND
X TORV LIMITS ER
L
B
EMPLOYERS LIABILITY
ANY PROPRIETOR/PARTNEft/EXECUTIVE
4021687
08�01�08
08/01/09
_
$ 1 000 000
EL EACH ACCIDENT
OFFICER/MEMBER EXCLUDED(
EL DISEASE EA EMPLOYEE
$ 1 000 000
If yes describe under
ELANxE! WAIVR SUBRCUATIDN
EL DISEASE POLICY LIMIT
$ 1 o00 o00
SPECIAL PROVISIONS below
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES! EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
The City of Fort Collins and CDOT are included as additional insureds on the
above general liability policy
Fax#494-4449
CITYFT5 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN
City of Fort Collins NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT BUT FAILURE TO DO SO SHALL
Purchasing 281 N College Avenue IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR
Fort Collins CO 80522 REPRESENTATIVES
A(ITHOR1TEP REPRESENTATI
S L��
ACORD 25 (2001108) (C) ACOR❑ CORPORATION 1PRR