HomeMy WebLinkAbout168787 GOLDEN TRIANGLE CONSTRUCTION INC - INSURANCE CERTIFICATE (7)ACORU. CERTIFICATE
OF LIABILITY INSURANCE
09/02/08°""""'
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
HRH of Colorado
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
720 South Colorado Boulevard
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Suite 600N
Denver, CO 80246
INSURERS AFFORDING COVERAGE
NAIC #
INSURED
..._..___ .
Golden Triangle Construction, Inc. INSURER B: Pinnacol Assurance 41190
700 Weaver Park INSURER C: O_neBeacon American Insurance Compan 20621
Longmont, CO 80501 INSURER D:
INSURER E:
VVVCRMVCJ
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.
INSRADD'
LTR
INSR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE (MMIDDiYYI
POLICY EXPIRATION
DATEIDD/YY
LIMITS
A
GENERAL LIABILITY
TCP2022866738
12/31/07
12131/08
EACH OCCURRENCE
$1 OQQOQO
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE 51OCCUR
DAMAGE TO RENTED
$500 000
$5 000
MED EXP (Any one person)
PERSONAL &ADV INJURY
$1000000
GENERAL AGGREGATE
$2 000 000
GEN'L AGGREGATE L 'MITAPPLIES PER
PRODUCTS - COMP/OP AGG
$2000000
POLICY X PRO,ECT X LOC
A
AUTOMOBILE
X
LIABILITY
ANYAUTO
C2022866741
12/31/07
12/31/08
COMBINED SINGLE LIMIT
(Ea accident)
$1000'OOQ
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
X
BODILY INJURY
(Per accident)
$
X
Physical Damage
ACV less Ded
PROPERTY DAMAGE
(Peraccident)
$
GAR AGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
$
AUTO ONLY: AGG
A
EXCESS/UMBRELLA LIABILITY
X OCCUR CLAIMS MADE
CUP2022866786
12/31/07
12131/08
EACH OCCURRENCE
$7000000
AGGREGATE
$] OOQ OOQ
$
DEDUCTIBLE
X RETENTION $ 10 000
$
B
WORKERS COMPENSATION AND
4013024
10/01/08
10/01/09
X WCSTATU- OTH.
EMPLOYERS' LIABILITY--
E.L. EACH ACCIDENT
$1 000,000
ANY PROPRIETOR/PARTNEMEXECUTIVE
E.L. DISEASE - EA EMPLOYEE
$1,000000
OFFICER/MEMBER EXCLUDED?
If yes, describe ender
SPECIAL PROVISIONS below
E.L. DISEASE - POLICY LIMIT 1
$1 QQO,OQQ
C
OTHER Leased Wor
790005057
01/01/08
12/31/08
$100,000less Ded
Rented Equipment
Owned Equipment
ACV less Ded
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
This Certificate of Insurance represents coverage currently in effect and
may or may not be in compliance with any written contract.
* The following cancellation conditions always apply:
(See Attached Descriptions)
City of Ft. Collins
215 N. Mason
PO Box 580
Fort Collins, CO 80524
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL _ *30_ 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
I T — gI ZED REPRE�., SENTg71VE
^��^� 1� "eul I OT a SIVIOul IUz 8NPER 0 ACORD CORPORATION 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 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.
AUUKU ZD-J tZUUI/UD) 2 of 3 #M601702
DESCRIPTIONS (Continued from Page 1) 1
- 10 days for non-payment of premium
-If policy shown, 10 days for Workers' Compensation for fraud;
material misrepresentation; non-payment of premium; other reasons
approved by the Commissioner of Insurance
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