HomeMy WebLinkAboutPINKARD CONSTRUCTION - INSURANCE CERTIFICATE (3)Q�M CERTIFICATE OF LIABILITY INSURANCE I M/DDYY)
10/22/08 1
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PRODUCER 1-303-534-4567 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
INA of Colorado, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
1550 17th Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Suite 600
Denver, CO 80202 INSURERS AFFORDING COVERAGE
INSURED INSURER A: Zurich American Insurance Company
Pinkard Construction
INSURER B: National Union Fire Ins. Co. of PA (AIG)
9195 West 6th Avenue INSURERC: Pinnacol Assurance
Lakewood, CO 80215 INSURERD _
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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,
INSfl
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
POLICY EXPIRATION 'ATE (MMIDDNY)
LIMITS
A
GENERAL LIABILITY
GL0369651204
11/01/08
11/01/09
EACH OCCURRENCE
$ 1,000,000
_
FIRE DAMAGE (Any one fire)
$300,000
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE O OCCUR
MED EXP (Any one person)
$ 10,000
PERSONAL &ADV INJURY
$1,000,000
X BI/PD Ded: $50,000
GENERAL AGGREGATE
$ 2,000,000
GENT AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
$2,000,000
PRO LOC
17 POLICY X JFCT
A
AUTOMOBILE
X
LIABILITY
ANY AUTO
BAP369651304
11/01/08
11/01/09
COMBINED SINGLE LIMIT
(Ea accident)
$ 11 000, 000
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
X
BODILY INJURY
(Per accident)
$
HIRED AUTOS
NON -OWNED AUTOS
X
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHERTHAN EAACC
$
ANY AUTO
$
AUTO ONLY: AGG
e
EXCESS LIABILITY
BE7275107
11/01/08
11/01/09
EACH OCCURRENCE
$ 10,000,000
X OCCUR F—ICLAIMS MADE
AGGREGATE
$ 10,000,000
$
DEDUCTIBLE
$
X RETENTION $10,000
C
WORKERS COMPENSATION AND
2321400
10/01/08
10/01/09
X I WC STATU. OTH.
TORY LIMITS ER
EMPLOYERS' LIABILITY
E.L. EACH ACCIDENT
$ 500,000
E.L. DISEASE - EA EMPLOYE
$500,000
E.L. DISEASE -POLICY LIMIT
$500,000
OTHER
5
a
$
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Certificate Holder is included as Additional Insured on the General Liability Coverage if required by written contract
or agreement subject to the policy terms and conditions. A Waiver of Subrogation is provided in favor of the Certificat
Holder on the General Liability and Workers Compensation Policies, if requried by written contract or agreement subject
to the policy terms and conditions.
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2004-1 Daft Odor Control.
City of Fort Collins
300 West La Porte Ave.
P.O. Box 580
Fort Collins. CO 80522
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
AUTHORIZED REPRESENTATIVE
ACORD
1VIAO413
USA
M
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.