HomeMy WebLinkAbout109420 HYDRO CONSTRUCTION CO INC - INSURANCE CERTIFICATE (63)ACORDM CERTIFICATE OF LIABILITY INSURANCE
3/30 M/DD/YY)
03/30/09
PRODUCER 1-303-534-4567
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
IMA of Colorado, Inc.
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
1550 17th Street
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Suite 600
Denver, CO 80202
INSURERS AFFORDING COVERAGE
INSURED
INSURER A: American Guarantee rti Liab. (Zurich American Ins)
Hydro Construction Company, Inc.
INSURER B: American Guarantee & Liab. (Zurich N. American Ins)
INSURER C: Pinnacol Assurance
301 East Lincoln Avenue
INSURERD:
Fort Collins, CO 80524
INSURER E:
t•`AVCOA!_CQ
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.
INSR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
POLICY EXPIRATION
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE FxI OCCUR
X PD Ded:$5,000
CP0343758104
09/30/08
09/30/09
EACH OCCURRENCE
$ 1,000,000
FIRE DAMAGE (Any one fire)
$ 300,000
MED EXP (Any one person)
$ 10,000
PERSONAL & ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY X PRO X LOC
PRODUCTS - COMP/OP AGG
$ 2,000,000
A
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
CP0343758104
09/30/08
09/30/09
COMBINED SINGLE LIMIT
(Ea accident)
$ 1,000,000
X
BODILY INJURY
(Per person)
$
X
BODILY INJURY
(Per accident)
$
X
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
ANY AUTO
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
AUTO ONLY: AGG
$
$
B
EXCESS LIABILITY
X OCCUR CLAIMS MADE
DEDUCTIBLE
X RETENTION $0
AUC593964000
09/30/08
09/30/09
EACH OCCURRENCE
$1,000,000
AGGREGATE
$ 1,000,000
$
$
C
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
2091550
04/01/09
04/01/10
X WCSTATU- OTH-
T RY LIMIT ER
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
E.L. DISEASE- POLICY LIMIT
$ 1,000,000
OTHER
$
s
S
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
City of Fort Collins is included as Additional Insured on the General Liability Policy if required by written contract
or agreement and with respect to work performed by Insured subject to the policy terms and conditions.
P
City of Fort Collins
Emergency Repair.
215 North Mason Street 2nd Floor
P.O. Box 580
Fort Collins, CO 80522
LETTER: (:ANI:tLLA 1 IUN
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
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
USA
ACORD 25-S (7/97) francine
11465489
O ACORD CORPORATION 1988
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.
ACORD 25-S (7/97)
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.
ACORD 25-S (7/97)
ACORDM CERTIFICATE OF LIABILITY INSURANCE
DA/30/0DD/YY)
0330/09
PRODUCER 1-303-534-4567
IMA of Colorado, Inc.
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
1550 17th Street
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Suite 600
Denver, CO 80202
INSURERS AFFORDING COVERAGE
INSURED
INSURER A:American Guarantee & Liab. (Zurich American Ins)
Hydro Construction Company, Inc.
INSURER B: American Guarantee & Liab. (Zurich N. American Ins)
INSURERC:Pinnacol Assurance
301 East Lincoln Avenue
INSURERD:
Fort Collins, CO 80524
"I
I INSURER E:
rnvConn1=e
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.
INSR LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE (MM
POLICY EXPIRATION
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE FxI OCCUR
X PD Ded:$5,000
CP0343758104
09/30/08
09/30/09
EACH OCCURRENCE
$1,000,000
FIRE DAMAGE (Anyone fire)
$ 300,000
MED EXP (Any one person)
$ 10,000
PERSONAL & ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY X PRO- g LOC
PRODUCTS - COMP/OP AGG
$ 2,000,000
A
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
CP0343758104
09/30/08
09/30/09
COMBINED SINGLE LIMIT
(Ea accident)
$ 1,000,000
X
BODILY INJURY
(Per person)
$
X
BODILY INJURY
(Per accident)
$
X
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
ANY AUTO
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
AUTO ONLY: AGG
$
$
B
EXCESS LIABILITY
X OCCUR CLAIMS MADE
DEDUCTIBLE
X RETENTION $ 0
AUC593964000
09/30/08
09/30/09
EACH OCCURRENCE
$ 1,000,000
AGGREGATE
$ 1,000,000
$
$
C
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
2091550
04/01/09
04/01/10
CT
X WRY IMIT I ER
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE- EA EMPLOYE
$ 1,000,000
E.L. DISEASE- POLICY LIMIT
$ 1,000,000
OTHER
$
5
$
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
City of Fort Collins is included as Additional Insured on the General Liability Policy if required by written contract
or agreement and with respect to work performed by Insured subject to the policy terms and conditions.
CFRTIFIr'ATF i4ni IIFR I I AnnR1nNA1 IIJCnwFn• IWAURFR I FTTFR- CANCELLATION
RE: Fort Collins WTF 2008 Phase II Improvements.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of Fort Collins
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
PO Box 580
REPRESENTATIVES.
Fort Collins, CO 80522-0000
AUTHORIZED REPRESENTATIVE
USA
ACORD 25-S (7/97) francine O ACORD CORPORATION 1935
11465468
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.
ACORD 25-S (7/97)
i
ACOORQM CERTIFICATE OF LIABILITY INSURANCE
3/30 M/DD/YY)
03/30/09
PRODUCER 1-303-534-4567
IMA of Colorado, Inc.
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
1550 17th Street
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Suite 600
Denver, CO 80202
INSURERS AFFORDING COVERAGE
INSURED
INSURER A: American Guarantee & Liab. (Zurich American Ins)
Hydro Construction Company, Inc.
INSURER B: American Guarantee & Liab. (Zurich N. American Ins)
INSURERC:Pinnacol Assurance
301 East Lincoln Avenue
INSURER D:
Fort Collins, CO 80524
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 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
POLICY EFFECTIVE
POLICY EXPIRATIONLTR
DATE (MM/DDNYI
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE 7 OCCUR
X PD Ded:$5,000
CP0343758104
09/30/08
09/30/09
EACH OCCURRENCE
$1,000,000
FIRE DAMAGE (Any one fire)
$300,000
MED EXP (Any one person)
$ 10,000
PERSONAL & ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY X PRO X LOC
PRODUCTS - COMP/OP AGG
$ 2,000,000
A
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
CP0343758104
09/30/08
09/30/09
COMBINED SINGLE LIMIT
(Ea accident)
$ 1,000,000
X
BODILY INJURY
(Per person)
$
X
BODILY INJURY
(Per accident)
$
X
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
ANY AUTO
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
AUTO ONLY: AGG
$
$
B
EXCESS LIABILITY
X I OCCUR CLAIMS MADE
DEDUCTIBLE
X RETENTION $ 0
AUC593964000
09/30/08
09/30/09
EACH OCCURRENCE
$ 1,000,000
AGGREGATE
$ 1,000,000
$
$
C
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
2091550
04/01/09
04/01/10
X WRYLAON R
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE- EA EMPLOYEE
$ 1,000,000
E.L. DISEASE- POLICY LIMIT
I $ 1,000,000
OTHER
S
S
$
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
RE: Mulberry Intermediate Replacement Project Phase 3 Headworks/Odor Control.
CERTIFICATE HOLDER I I ADDITIONAL INSURED: INSURER LETTER: CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City Of Fort Collins
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
PO Box 580
REPRESENTATIVES.
Fort Collins, CO 80522-0000
USA
AUTHORIZED REPRESENTATIVE
[/
ACORD 25-S (7/97) francine O ACORD CORPORATION 1988
11465480
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.
ACORD 25-S (7/97)
AC"R . CERTIFICATE OF LIABILITY INSURANCE
3/30 M/DD/YY)
03/30/09
PRODUCER 1-303-534-4567
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
IMA of Colorado, Inc.
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
1550 17th Street
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Suite 600
Denver, CO 80202
INSURERS AFFORDING COVERAGE
INSURED
Hydro Construction Company, Inc.
INSURER A: American Guarantee & Liab. (Zurich American Ins)
INSURER B: American Guarantee & Liab. (Zurich N. American Ins)
INSURER C:Pinnacol Assurance
301 East Lincoln Avenue
INSURERD:
Fort Collins, CO 80524
INSURER E:
rrnvronncc
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.
INSR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE (MWDDNYI
POLICY EXPIRATIONLTR
DATE (MM/DD/YY1
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE El OCCUR
X PD Ded:$5,000
CP0343758104
09/30/08
09/30/09
EACH OCCURRENCE
$ 1,000,000
FIRE DAMAGE (Anyone fire)
$300,000
MED EXP (Any one person)
$ 10,000
PERSONAL & ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY X PRO X LOC
PRODUCTS - COMP/OP AGG
$ 2,000,000
A
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
CP0343758104
09/30/08
09/30/09
COMBINED SINGLE LIMIT
(Ea accident)
$ 1,000,000
X
BODILY INJURY
(Per person)
$
X
BODILY INJURY
(Per accident)
$
X
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
ANY AUTO
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
AUTO ONLY: AGG
$
$
B
EXCESS LIABILITY
X OCCUR 1:1CLAIMS MADE
XIDEDUCTIBLE
RETENTION $ 0
AUC593964000
09/30/08
09/30/09
EACH OCCURRENCE
$ 1,000,000
AGGREGATE
$ 1,000,000
$
$
C
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
2091550
04/01/09
04/01/10
X WCSTATU- OTH-
LIMIT ER
TT
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYE
$1,000,000
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
OTHER
$
S
8
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
RE: Mulberry Intermediate Replacement Project Demolition Phase.
CERTIFICATE HOLDER I I ADDITIONAL INSURED: INSURER LETTER: CANCELLATION
City of Fort Collins
PO Box 580
Fort Collins, CO 80522-0000
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
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE S ♦ i
USA
ACORD 25-S (7/97) francine OACORD CORPORATION 1988
11465478
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.
ACORD 25-S (7/97)
r
ACOR M CERTIFICATE OF LIABILITY INSURANCE
3/30 M/DD/YY)
03/30/09
PRODUCER 1-303-534-4567
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
IMA of Colorado, Inc.
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
1550 17th Street
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Suite 600
Denver, CO 80202
INSURERS AFFORDING COVERAGE
INSURED
INSURER A: American Guarantee & Liab. (Zurich American Ins)
Hydro Construction Company, Inc.
INSURERB:American Guarantee & Liab. (Zurich N. American Ina)
INSURER Pinnacol Assurance
301 East Lincoln Avenue
INSURERD:
Fort Collins, CO 80524
INSURER E:
nnvroAcrc
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.
INSR
7ypE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE IN
POLICY EXPIRATIONLTR
AMIDDNY)
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE Fx_1 OCCUR
X PD Ded:$5,000
CP0343758104
09/30/08
09/30/09
EACH OCCURRENCE
$ 1,000,000
FIRE DAMAGE (Any one fire)
$ 300,000
MED EXP (Any one person)
$ 10,000
PERSONAL & ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$2,000,000
GENT AGGREGATE LIMIT APPLIES PER:
POLICY X JECT PRO X LOC
PRODUCTS- COMP/OP AGG
$ 2,000,000
A
AUTOMOBILE
X
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
CP0343758104
09/30/08
09/30/09
COMBINED SINGLE LIMIT
(Ea accident)
$ 1,000,000
BODILY INJURY
(Per person)
$
X
BODILY INJURY
(Per accident)
$
X
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
ANY AUTO
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
AUTO ONLY: AGG
$
$
B
EXCESS LIABILITY
X OCCUR CLAIMS MADE
DEDUCTIBLE
X RETENTION $ 0
AUC593964000
09/30/08
09/30/09
EACH OCCURRENCE
$ 1,000,000
AGGREGATE
$ 1,000,000
$
$
$
C
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
2091550
04/01/09
04/01/10
X WRYLIMITS I I OER
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYEE
S 1,000,000
E.L. DISEASE -POLICY LIMIT
$1,000,000
OTHER
$
5
S
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
CERTIFICATE HOLDER I I ADDITIONAL INSURED; INSURER LETTER: CANCELLATION
RE: DWRF 2008 Demolition Project. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of Fort Collins 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
PO BOX 580 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
Fort Collins, CO 80522-0000 AUTHORIZED REPRESENTATIVE
USA
ACORD 25-S (7/97) francine G ACORD CORPORATION 1988
11465482