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Home My WebLink AboutCORRESPONDENCE - GENERAL CORRESPONDENCE - INSURANCE CERTIFICATECOLORADO-BW INSURANCE Fax 19702672231 Mar 18 2009 09:34am P003/003 Policy Number: GL 8492530 Coverage Is Provided In COLORADO CASUALTY INSURANCE, COMPANY Named Insured: Agent: CAMPANA CONSTRUCTION CORP COLORADO - BW INSURANCE AGENCY , INC Agent Code: 5900414 Agent Phone: (970)-223-0924 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the folfowing: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) CITY OF FT COLLINS BUILDING & PERMITS PO BOX 580 FT COLLINS, CO 80522 Information required to complete this Schedule, if not shown above, will be shown in the Declarations_ Section If — Who Is An Insured is amended to Include as an additional insured the persons) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or 'personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: A. In the performance of your ongoing operations: or B. in connection with your premises owned by or rented to you. 0 ISO Propeniss. Inc.. 2004 CG 20 26 (07104) AGENT COPY DW22/2 5 8492530 NN163729 2108 PGDMOWO J29223 LCAFPPN QW08 se Page 5 COLORADO-BW INSURANCE Fax 19702672231 Mar 18 2009 09:34am 1`001/003 ACORN. CERTIFICATE OF LIABILITY INSURANCE 03i silo ' PRODUCER (970)223-0924 FAX (970)267-2231 Colorado 8W Insurance Agency, Inc. I075 W Hprsetooth Rd, Ste 106 Fort Collins, CO 80526 Dennis Shafer 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 NAIL # INSURED Campana Construction Corp 5100 Abbey Rd Fort Collins, CO 80526-3952 iNSURERA Colorado Casualty Insurance 41785 INSURER B: INSURER C: INSURER D; INSURER E. nnvFRSf:FC THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN 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 TYPE OF INSURANCE POLICY NUMBER POLK:Y EFFECTIVE POLIOY EXPIRATION DATE IMMWO LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE I OCCUR 6L8492530 09/22/2008 09/22/2009 EACH OCCURRENCE S 1 00,000 DAMAGE TO RENTED s lOO, OO MEO EXP (Any one parson) $ 5,()()0 PERSONAL &AOV INJURY $ 11000,000 GENERAL AGGREGATE 8 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: 1-1 POLICY PRO" LOC JECT PRODUCTS - COMPIOPAGG $ 21000,000 AUTOMOBILE LIABILITY ANYAUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS _ COMBINED SINGLE LIMIT (Esacdtlent) $ BODILY INJURY (Par person) $ BODILY INJURY (Per acddent) PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO . AUTO ONLY- EAACCIOENT $ OTHERT14AN EAACC AUTO ONLY: AGG $ $ EXCESWUMBRELLA LIABILITY OCCUR CLAIMS MADE DEDUCTIBLE RETENTION S EACH OCCURRENCE $ AGGREGATE S $ $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? If yas, describe under SPECIAL PROVISIONS helaw WC STATU- OTH- E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS he Certificate Holder is named as an Additional Insured, City of Fort Collins Puchasing Department P.O. Box 580 Fart Collins, CO 80522 SHOULD ANY OF THE ABOVE DE$OR181"D POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO NAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INS ITS AGENTS OR AUTHORL= REPRO;NTA I ACORD 26 (2001108) FAX: (970) 221-6707 1 ®ACORD WAAORATION 1988 COLORADO-BW INSURANCE Fax 19702672231 Mar 18 2009 09:3dam P002/003 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 terns 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. AGORD 25 (2001108)