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HomeMy WebLinkAboutRC HEATH - INSURANCE CERTIFICATEClient#:25306 RCHEA ACORD,,,, CERTIFICATE OF LIABILITY INSURANCE DATE jM. 12/10/08 Dnvrv) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Flood & Peterson Insurance Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 4821 Wheaton Drive HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P O Box 270370 Fort Collins, CO 80527 INSURERS AFFORDING COVERAGE NAIC # INSURED R.C. Heath Construction Co., Inc. P. 0. Drawer H Fort Collins, CO 80522 INSURER A: Travelers Insurance Company INSURER B: Everest National Insurance Company INSURER C: Pinnacol Assurance INsuRER D: Fireman's Fund Insurance NSURER 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. LTR NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MMIDOIVY POLICY EXPIRATION DATE MMIDDIYY LIMITS A GENERAL LIABILITY DTCO298N6651 09/30/08 09/30/09 EACH OCCURRENCE _ S1,000,000 X COMMERCIAL GENERAL LIABILITY TO RcEbENTED cc eni,e) DAMAGEISFS S300OOO CLAIMS MADE � OCCUR MED EXP (Any one person) $5 000 PERSONAL &ADV INJURY $1,000,000 X PD Ded:10.000 GENERAL AGGREGATE S2 000 000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP ADS s2000000 POLICY PRO- JECT OC A AUTOMOBILE LIABILITY ANY AUTO DT810298N665 09/30/08 09/30/09 COMBINED SINGLE LIMIT (Ea .,,leant $1,000,000 X BODILY INJURY (Per person) S ALL OWNED AUTOS SCHEDULED AUTOS X BODILY INJURY (Per accident) $ HIRED AUTOS NON OWNED AUTOS X X PROPERTY DAMAGE (Per accident S Drive Other Car GARAGE LIABILITY AUTO ONLY - EA ACCIDENT S OTHER THAN EA ACC S ANY AUTO $ AUTO ONLY: AGG B EXCESSIUMBRELLA LIABILITY 71CH000017081 09/30/08 09/30/09 EACH OCCURRENCE $5000000 OCCUR CLAIMS MADE AGGREGATE s5,000,000 S $ DEDUCTIBLE $ RETENTION S C WORKERS COMPENSATION AND 4033691 10/01/08 10/01/09 X WC STATUS OTH- EMPLOYERS UABIUTY ANY PROPRIETORIPARTNERIEXECUTIVE E.L. EACH ACCIDENT $1,000,000 EL.MSEASE-EAEMPLOYEE $1,000,000 OFFICERIMEMBER EXCLUDED? 11 yes, describe antler SPECIAL PROVISIONS below EL.DISEASE - POLICY LIMIT $1,DDD,DDD D OTHER Blanket MX198471771 09/30/08 09/30/09 $10,000,000 Limit Reporting Form $1,000 deductible Builders Risk DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT SPECIAL PROVISIONS RE: Bayer License agreement for SE Branch. Bayer, Front Range Retail Company, LLC, and Front Range Village Building 400 Planned Community Fort Collins Regional Library District are named as additional insureds. (See Attached Descriptions) South East Branch Library 2733 Council Tree Ave Fort Collins. CO 80525 LD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL _30_ DAYS WRITTEN 'E TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL ;E NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR ACORD 25 (2001/08) 1 of 3 #S431351/M426735 CAZ © 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. ACORD 25-S (2001108) 2 of 3 #S431351/M426735 DESCRIPTIONS (Continued from Page 1) 12/10/08 Mailed to holder, emailed to Tonya at Heath AM5 Z5.3 (ZUUIIUU) 3 of J #5431351/M42b735