HomeMy WebLinkAbout124455 SUPERIOR ROOFING - INSURANCE CERTIFICATE (2)ACORD,, CERTIFICATE OF LIABILITY INSURANCE 0DATE (MM/D
4/30/09Dm)
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Van Gilder Insurance Corp. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
1515 Wynkoop, Suite 200 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Denver, CO 80202
303 837-8500 INSURERS AFFORDING COVERAGE
INSURED INSURER A: Continental Casualty Company (CNA)
Superior Roofing, Inc. INSURER B: National Union Fire Ins Co (AIG)
74700 East 39th Avenue
INSURER C:
Aurora, CO 80011
INSURER D:
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.
NSR
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE MM/DD%
POLICY EXPIRATION
DATE (MM/DD1YY1
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE Fx_1 OCCUR
4014418635
05/01/09
05/01/10
EACH OCCURRENCE
$1,000,000
FIRE DAMAGE (Any one fire)
$300 000
MED EXP (Any one person)
$1 O 000
PERSONAL & ADV INJURY
$1,000,000
GENERAL AGGREGATE
s2,000,000
GEN'L AGGREGATE LIM ITAPPLIES PER:
POLICY X PE El LOC
PRODUCTS -COMP/OPAGG
s2,000,000
A
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
4014418649
05/01/09
05/01/10
COMBINED SINGLE LIMIT
(Ea accident)
$1,000,000
X
BODILY INJURY
(Per person)
$
X
BODILY INJURY
(Per accident)
$
X
PROPERTY DAMAGE
(Per accident)
$
r
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 $10000...
80878773
05/01/09
-
05/01/10
EACH OCCURRENCE
$5 000 000
AGGREGATE
s5,000,000
$
$
A
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
4014418621
05/01/09
05/01/10
X WC STATU- OTH-
T RY LIMIT R
E.L. EACH ACCIDENT
$1,000,000
E.L. DISEASE - EA EMPLOYEE
$1,000,000
E.L. DISEASE -POLICY LIMIT
$1,000,000
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
`Except 10 days notice for non-payment of premium.
RE: Ft Collins Utilities
As required by written contract or written agreement, the City of Ft. Collins is included as Additional Insured for ongoing
operations under General Liability.
INSURER LETTER:
City of Ft. Collins, Purchasing
PO Box 580
Fort Collins, CO 80522
SHOULD ANYOF TH E ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TOMAIL*30_DAYSWRI7TEN
NOTICE TOTHE CERTIFICATE HOLDERNAMED TOTHE LEFT, BUTFAILURE TODOSOSHALL
IM POSE NO OBLIGATION OR LIABILITYOF ANYKIND UPON TH E INSURERJTS AGENTS OR
A HORIZED REPRESENTATIV
ACORD 25-5 (7/97)1 of 2 #M565601 KLT 0 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) 2 of 2 #M 5 6 5 6 01