HomeMy WebLinkAboutCORRESPONDENCE - GENERAL CORRESPONDENCE - INSURANCE CERTIFICATE (2)"A CERTIFICATE OF LIABILITY INSURANCE
DATE (MM
03/06/2009YY)
/2009
PRODUCERPIN
7501 E Lowry Blvd OL ASSURANCE
501
Denver, CO 80230-7006
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY
AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE
COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE NAIC#
INSURED
INSURERA: PINNACOL ASSURANCE
41190
POTTER COMMERCIAL WALLS AND CEILINGS INC
43600 HWY 50E
AVONDALE, CO 81022
INSURERS
INSURER
INSURER D.
D
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDNG
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMMENT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
ADD'L
POLICY EFFECTIVE
POLICY EXPIRATION
LTR
INSRD
TYPE OF INSURANCE
POLICYNUMBER
DATE(MM/DD/YYYY)
DATE(MM/DD/YYYY)
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
DAMAGE TO RENTED
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE OCCUR
PREMISES
MED EXP(Any one person)
PERSONAL 8 ADV INJURY
GEN'L AGGREGATE LIMIT APPLIERS PER:
GENERAL AGGREGATE
PRODUCTS - COMP/OP AGG
POLICY 11 PROJECTE LOC
AUTOMOBILE UABIUTY
COMBINED SINGLE LIMIT
ANY AUTO
(Ea Accident)
BODILY INJURY
ALL OWNED AUTOS
SCHEDULED AUTOS
(Per person)
BODILY INJURY
HIRED AUTOS
NON -OWNED AUTOS
(Per accident)
PROPERTY DAMAGE
(Per accident)
GARAGE LIABILITY
AUTO ONLY- EA ACCIDENT
OTHER THAN EA ACC
ANY AUTO
AUTO ONLY: AG
EXCESSIUMBRELLA LIABILITY
EACH OCCURRENCE
OCCUR CLAIMS MADE
AGGREGATE
DEDUCTIBLE
RETENTION $
WORKERS COMPENSATION AND
A WC STATU- OTHER
A
EMPLOYER'S LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
4102271
02/01/2009
02/01/2010
TORY LIMITS
E.L EACH ACCIDENT
$1.000,000
OFFICER/MEMBER EXCLUDED?
E.L DISEASE - EA EMPLOYEE
$1,000,000
If yes, please describe under SPECIAL PROVISIONS below
E.L DISEASE -POLICY LIMIT
$1000000
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
CERTIFICATE HOLDER
CANCELLATION
1138726
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Fort Collins
THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
P.O. Box 580
MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
Fort Collins CO 80522
LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
Ryan Lanter
ACORD 25(2001108)
Underwriter ACORD CORPORATION 1988
CERTIFICATE HOLDER COPY
City of Fort Collins
P.O. Box 580
Fort Collins CO 80522
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.