HomeMy WebLinkAbout467727 DRAHOTA COMMERCIAL LLC - INSURANCE CERTIFICATE (3)ACORD. CERTIFICATE OF LIABILITY INSURANCE 7/l/2009 DATE
11/26/2 s'
PRODUCER Lockton Companies, LLC Denver THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
8110 E Union Avenue ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Suite 700 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
Denver 80237 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
(303) 414-6000
INSURERS AFFORDING COVERAGE I NAIC #
INSURED Drahota Commercial, LLC
1054659 PO Box 272269
Fort Collins, CO 80527
INsuRER B: Pinnacol Assurance i
INSURER C N Uonal Union Fire his. Co. of PA
INSURER D.
Cr1VFRA4198 F)R ACOn l V X THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING
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
ABUT
INSRD
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE (MMIDD/YY)
POLICY EXPIRATION
DATE (MMIDDffY)
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$ 1 1000MO
A
X COMMERCIAL GENERAL LIABILITY
GLA375796405
12/1/2008
12/1/2009
DAMAGE TO RENTED
MED EXP (Any one person))
$ 10,000000
CLAIMS MADE � OCCUR
_
PERSONAL &ADV INJURY
$ 1000000
GENERAL AGGREGATE
$ 2,000,000
GENT AGGREGATE LIMIT APPLIES PER.
PRODUCTS - COMP/OP AGO
$ 2000000
O-
POLICV XI JEPRCT X LOC
A
AUTOMOBILE
X
LIABILITY
ANY AUTO
GLA375796405
12/l/2008
12/1/2009
COMBINED SINGLE LIMIT
(Ea accident)
$ 1'000'000
BODILY INJURY
(Per person)
$ XXXXXXX
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY
(Peraccidenp
$ XXXXXXX
HIRED AUTOS
NON-OWNEDAUTOS
PROPERTY DAMAGE
(Per accident)
$ XXXXXXX
GARAGE LIABILITY
ANY AUTO
NOTAPPLICABLG
AUTO ONLY - EAACCIDENT
$ XXXXXXX
OTHER THAN EA ACC
$ XXXXXXX
AUTO ONLY: AGG
$ XXXXXXX
C
EXCE$$IUMBRELLALIABILITY
X
OCCUR F—ICLAIMS MADE
I3E015872766
12/1/2008
12/I/2009
EACH OCCURRENCE
$ 5000000
AGGREGATE
$ 5 000 000
$ XXXXXXX
UMBRELLA
191
$ XXXXXXX
DEDUCTIBLE FORM
$ XXXXXXX
RETENTION $
H
WORKERS COMPENSATION AND
2286970
7/I/2008
7/I/2009
X+ WC STATU- DTH-
im
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
EL. EACH ACCIDENT
$ 1'000'000
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
OFFICERIMEMBER EXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below NO
I
I
EL DISEASE -POLICY LIMIT
S 1000000
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
Fit 123 General Contractor for Fire Station Expansion and Renovation Projects.
3636645 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
n
City of Fort Collins DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN
Financial Services - Purchasing Division NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO $O SHALL
215 N. Mason Street, 2nd Floor IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
P.O. Box 580
Fort Collins, CO 80522 REPRESENTATIVES.
AUTHORIZED REPRES T E
C
rC w
ACORD 25(2001/08) For questions regarding this certificate, contact the number listed in the 'Producer section above and sneciry he Niem co do DRACodt'. AGORA r.oRPr1RATI0N 1QRR