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Home My WebLink AboutHALL IRWIN - INSURANCE CERTIFICATE (2)Client#- 44870 HALIRI ACORD,,., CERTIFICATE OF LIABILITY INSURANCE DATE 12/19108Dnrvv) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Flood & Peterson Ins. Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P. O. Box 578 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 4687 W.18th Street Greeley, CO 80632 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Travelers Insurance Company Hall Irwin Corporation INSURERS: Pinnacol Assurance Attn: Kurt Sultzman 301 Centennial Dr INSURER Q Milliken, CO 80543-3222 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 15 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 MFFECTIV POLICY EXPIRATION DATE EXPIRATION LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE 51 OCCUR X PDDed:5,000 DTC07212M7431ND08 12/31/08 12/31/09 EACH OCCURRENCE $1000000 DAMAGE TO RENTED PREMISES Ea occ rr nce $3OO OOO MED EXP (Any one person) $10 000 PERSONAL & ADV INJURY S1000000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMITAPPLIES PER: POLICY JE° LOC 1:1 PRODUCTS - COMPIOP AGO S20000-00 A AUTOMOBILE LIABILITY ANYAUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS DT8107212M743TIL08 12/31/08 12/31/09 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 X BODILY INJURY (Per person) $ X BODILY INJURY Per accident) S X PROPERTY DAMAGE (Per accident) S GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT S OTHERTHAN EA ACC AUTO ONLY: AGO S S A EXCESS/UMBRELLA LIABILITY X OCCUR CLAIMS MADE DEDUCTIBLE X RETENTION $ 10 000 DTSMCUP7212M743TIL 12/31/08 12/31/09 EACH OCCURRENCE $5000000 AGGREGATE $5 00O 000 $ S S B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOWPARTNIMEXECUTIVE OFFICEMMEMBER EXCLUDED? 11 yes, describe under SPECIAL PROVISIONS below 4021105 01/01/09 01/01/10 X WCSTATU- OTH T V LIMIT R EL. EACH ACCIDENT $SOO,000 E.L. DISEASE - EA EMPLOYEd $500,000 E.L. DISEASE -POLICY LIMIT I S500,000 A OTHER Equipment QT66099OX1144TIL09 01/01/09 01/01/10 Blanket Limit Deductible: $5,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Certificate holder is added as an additional insured. ua City of Fort Collins P. O. Box 580 Fort Collins, CO 80522-0580 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR ACORD 25 (2001/08) 1 of 2 #M432670 DR O ACORD CORPORATION 198E IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer($), 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. AL;UKD z5.5 (zuuvua) 2 of 2 #M432670