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Home My WebLink About168787 GOLDEN TRIANGLE CONSTRUCTION INC - INSURANCE CERTIFICATE (10)Client#: 51920 RrY11 nTRI1 ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATE 121121080mvv) 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 60ON — Denver, CO 80246 INSURERS AFFORDING COVERAGE NAIC # INSURED Golden Triangle Construction, Inc. 700 Weaver Park Rd. Longmont, CO 80501 INSURERA. CNA Insurance Companies B6486 INSURER B: Pinnacol Assurance 41190 _ INSURER C: OneBeacon American Insurance Compan 20621 ---"""'— 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, INSR LTR ADD'L INSRt TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM DDm POLICY EXPIRATION ATE MM DDIVV LIMITS A GENERAL LIABILITY TCP2022866738 12/31/08 12/31/09 EACH OCCURRENCE $1 000 000 X COMMERCIAL GENERAL LIABILITY DAMAGEPREMISESEa occurrence) $500000 MED EXP (Any one person) $5 000 CLAIMS MADE 5x1 OCCUR PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE s2,000,000 GEH'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGO s2000000 POLICY X JECPR- X LOC A AUTOMOBILE X LIABILITY ANY AUTO C2022866741 12/31 /08 12131 /09 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS X BODILY adrid M) (Per accitlenl) $ HIRED AUTOS NON -OWNED AUTOS X PROPERTY DAMAGE (Per accident) $ Physical Damage ACV less Ded GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY: AGG A EXCESSIUMBRELLA LIABILITY OCCUR 7 CLAIMS MADE CUP2022866786 12/31/08 12/31/09 EACH OCCURRENCE s7000000 X AGGREGATE s7,000,000 S $ DEDUCTIBLE X $ RETENTION $10.000 B WORKERS COMPENSATION AND 4013024 10/01/08 10/01/09 X WCSTATU- O(H- EMPLOVERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $1000000 E.L. DISEASE - EA EMPLOYEE $1,000,000 OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $1,000,000 C OTHER Leased &/or 790005057 12/31/08 12/31/09 $100,000 less Ded Rented Equipment Owned Equipment ACV less Ded DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I 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 = 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 A{1TH0 IZED REPRESENTATIVE ACORD 25 (2001108) 1 of 3 #M615525 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. ACORD 25-S (2001/08) 2 of 3 #M615525 DESCRIPTIONS (Continued from Page 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 AMS 25.3 12001/O8) 3 of 3 #M615525