HomeMy WebLinkAboutRC HEATH CONSTRUCTION - INSURANCE CERTIFICATE (2)client#• 25308
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ACORDn., CERTIFICATE OF LIABILITY
INSURANCE
DATE
1215108DDnrvv)
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 9
INSURED
R.C. Heath Construction Co., Inc.
P. O. Drawer H
Fort Collins, CO 80522
INSURER A: Travelers Insurance Company
INSURER B: Everest National Insurance Company
INSURER C: Pinnacol Assurance
—
INSURER D:
INSURER 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
INSR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE MMIODIYV
POLICY EXPIRATION
DATE MMIDDIYV
LIMITS
A
GENERAL LIABILITY
DTCO298N6651
09/30/08
09/30/09
EACH OCCURRENCE
S11000000
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE a OCCUR
DAMAGE TO RENTED
$300OOO
MED EXP (Any one person)
S5 DDD
PERSONAL &ADV INJURY
$1,000,000
X PD Ded:10,000
GENERAL AGGREGATE
$2 DOD 000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMPIOPAGG
$2006060
POLICY PRO-
JECT OC
A
AUTOMOBILE
LIABILITY
ANY AUTO
DT810298N665
09/30/08
09/30/09
COMBINED SINGLE LIMIT
(Ea accitleM)
51,000,000
X
BODILY INJURY
(Per person)
S
ALL OWNED AUTOS
SCHEDULED AUTOS
X
BODILY INJURY
(Per accident)
$
HIRED AUTOS
NON-OWNEOAUTOS
X
X
PROPERTY DAMAGE
(Per accident)
$
Drive Other Car
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
S
OEA ACC
AN
$
ANY AUTO
S
AUUTOTO ONLY qGG
B
EXCESSAMBRELLA LIABILITY
OCCUR FXI CLAIMS MADE
71CH000017081
09/30/08
09/30/09
EACH OCCURRENCE
$5000000
AGGREGATE
s5,000,000
S
S
DEDUCTIBLE
$
RETENTION S
C
WORKERS COMPENSATION AND
4033691
10/01/08
10/01/09
X WC STATU OTH-
EMPLOYERS' LIABILITY
ANY PROPRIETORIPARTNERIEXECUTIVE
EL, EACH ACCIDENT
$1,000,000
E.L. DISEASE - EA EMPLOYEE
$1,000,000
OFFICERIMEMBER EXCLUDED?
If
SPECIAL PROVISIIONS below
E.L. DISEASE - POLICY LIMIT
$1,000,000
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I 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.
1215/08 Mailed to holder, emailed to Tonya at Heath
South East Branch Library
2733 Council Tree Ave
Fort Collins, CO 80525
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 $0 SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
ACORD 2512001/98) 1 of 2 #S431351/M426735 CAZ 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.
HVVRV GJV t1W 1/VO/ Z of Z #5431351/M426735