HomeMy WebLinkAboutRANACK CONSTRUCTORS - INSURANCE CERTIFICATE (5)ACORD,. CERTIFICATE OF LIABILITY INSURANCE OP ID RC DATE (MM DDM YY)
RANAC-1 Ol 30 09
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
LBN Insurance Agcy-Johnstown HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
4848 Thompson Pkwy, Ste 200 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Johnstown CO 80534
Phone:970-635-9400 Fax:970-635-9401 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: pnitaG 9yacia1ty za• Compmy
INSURER B: Pinnacol Assurance 41190
Ranack Constructors, Inc INSURERC: Employers Mutual
652 S Cty Road 9E INSURER D:
Loveland CO 80537
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 MAYBE 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.
INS 00' P LILVEFFECTIVE iPOLICY EXPIRATION
LTR INSRO TYPE OF INSURANCE POLICY NUMBER DATE MMIDO/YY DATE MM/DOM' LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$1,000,000
PREMISES (Eaocaranw)
E.50,000
A
MERCIAL GENERAL LIABILITY
X COMMERCIAL
STL4100091-00
02/02/09
02/02/10
�
CLAIMS MADE X OCCUR
MED EXP (Any one person)
$ 5., 000
PERSONAL B ADV INJURY
$1,000,000
X BLNICT ADD'L INS.
GENERAL AGGREGATE
$2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS-COMP/OP AGG
52,000,000
POLICY X PRO. LOC
JECT
C
AUTOMOBILE LIABILITY
ANY AUTO
2EB2430 02/02/09
02/02/10
COMBINED SINGLE LIMIT
(Eaacddenl)
E1,000,000
BODILY INJURY
(Per person)
E
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY
(Per accident)
$.
X HIRED AUTOS
I
X NON -OWNED AUTOS
PROPERTY DAMAGE
(Per awidenU
S
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
S
AUTO ONLY: AGE
EXCESSIUMBRELL�A LIABILITY
EACH OCCURRENCE
S
OCCUR CLAIMS MADE
LI
AGGREGATE
$
S
$
DEDUCTIBLE
E
RETENTION S
WORKERS COMPENSATION AND
B EMPLOYERS' LIABILITY
ANY PROPRIETOWPARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
4070965
07/01/08
07/Ol/09
X TORY LIMITS ER
E.L. EACHAccIDENT
$1,000,000
E.L. DISEASE - EA EMPLOYEE
$1,000,000
If Yes, describe ender
SPECIAL PROVISIONS below
E.L. DISEASE - POLICY LIMIT
$1,000,000
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
All Operations - All Locations. License number: B107. The City of Fort
Collins is named as an additional insured in regards to the general
liability.
CERTIFICATE HOLDER CANCELLATION
CITYFCO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES HE 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
City of Fort Collins IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
P.O. BOX 580 REPRESENTATIVES.
Fort Collins CO 80522-0580 AUT WA1E RESE)7,ATIy Alm A. •
LYI oLLK•]3•ZK•]Jl•]:7_YR•i`iFB1I
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