HomeMy WebLinkAboutCORRESPONDENCE - GENERAL CORRESPONDENCE - INSURANCEACORQ. CERTIFICATE OF LIABILITY INSURANCE GP ID JL DATE(MM/DD/YVVV)
1
NORMA-1 03 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: mountain State. I..urance Gcp
INSURERB: Pinnacol Assurance
41190
INSURERC
Normandin Construction, Inc.
03 Collins CO Road
Fort Collins CO 80526
INSURER D.
...
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.
POLICY EFFECTIVE PDLICY EXPIRATION
LTR NSRE TYPE OFINSURANCE POLICY NUMBER DATE MMIDDIYI' PATE (MM/DDfYYI LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
51,000,000
A
X COMMERCIAL GENERAL LIABILITY
BINDER
04/01/09
04/01/10
-DAMAGETO-RENTED...
PREMISES(Ea occurence)_
___.__..._
$100,000
CLAIMS MADE }' OCCUR,
MED EXP (Am one person)
$10 , 000
A
X BLANKET ADD'L INS
BINDER
04/01/09
04/01/10
PERSONAL & ADV INJURY
$1,000,000
X
BLANKET WAIVER OF
A
BINDER
04/01/09
04/01/10
GENERAL AGGREGATE
_
s2,000,000
GENT AGGREGATE LIMIT APPLIES PER:
PRODUCTS-COMP/OP AGG
52,000,000
POLICY X JPECTRO- LOC
_
AUTOMOBILE
LIABILITY
C
ANY AUTO
BINDER
04/01/09
04/01/10
COMBINED SINGLE LIMIT
(Ea accident)
$1 QQQ Q 00
r r
ALLOWNEDAUTOS_
---------------
-
BODILY INJURY
S
SCHEDULED AUTOS
(Per person)
HIRED AUTOS
BODILY INJURY
S
NON -OWNED AUTOS
(Per accident)
PROPERTY DAMAGE
$
-
..... -----------
(Per accident)
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
S
ANY AUTO
N/A
OTHER THAN EA ACC
S
AUTO ONLY: AGG
5
EXCESS/UMBRELLA LIABILITY
EACH OCCURRENCE
$1,000,000
A
X OCCUR CLAIMS MADE
BINDER
04/01/09
04/01/10
AGGREGATE
S1,000,00C
DEDUCTIBLE
5
X RETENTION S10, QQQ
5
WORKERS COMPENSATION AND
X TWU LIMITS X ER
--..--_
EMPLOYERS' LIABILITY
PROPRIETOR/PAR"i NEWEXECUI'IVE
4097-958
11/0.1/08
11/01/09
EL.EACIACCIDENT
$1000000
FRIG R/MEMSEREXCLUDED?
_
E.L. DISEASE - EA EMPLOYEE
- -
$1000000
If yes, describe under
.-..-
E.L.DISEASE-POLICYLIMIT
51000000
SPECIAL PROVISIONS below
OTHER
C
Equipment Floater
BINDER
04/01/09
04/01/10
Scheduled $583,000
Deductibl $1,000
DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
All Locations / All Operations
CITYFT3 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 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,
Ft. Collins, CO 80522 AUT 1WAEYRESEerAT11 - w
ACORD 25 (2001/08) n ACORD CORPORATION 10AR
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.