HomeMy WebLinkAboutCORRESPONDENCE - GENERAL CORRESPONDENCE - INSURANCEDATE
ACORD,, CERTIFICATE OF LIABILITY INSURANCE 06/22/09DNY)
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: Travelers Indemnity Company
Felsburg Holt St Ullevig, Inc. INSURER B: The Phoenix Ins. Co (SPT)
Cent S. Syracuse Way, #600 INSURER c: Hartford Accident & Indemnity
Centennial, CO 80111 INSURER D: XL Specialty Insurance Company
INSURER E:
r0T611l y _11TO =9
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/YY
POLICY EXPIRATION
DATE MM/DD/YY
LIMITS
A
GENERAL LIABILITY
68022781-711
06/21/09
06/21/10
EACH OCCURRENCE
$1,000,000
FIRE DAMAGE (Any one fire)
$1 00n000
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE F7X OCCUR
MED EXP (Any one person)
$1 Q 000
PERSONAL & ADV INJURY
$1,000,000
GENERAL AGGREGATE
$2 000 000
GEN'L AGGREGATE LIMITAPPLIES PER:
PRODUCTS - COMP/OP AGG
s2,000,000
POLICY PRO LOC
JECT
B
AUTOMOBILE
LIABILITY
ANY AUTO
BA30081_260
06/21/09
06/21/10
COMBINED SINGLE LIMIT
(Ea accident)
$1,000,000
X
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
X
HIRED AUTOS
NON -OWNED AUTOS
BODILY INJURY
(Per accident)
$
X
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
$
AUTO ONLY: AGG
A
EXCESS LIABILITY
X OCCUR CLAIMS MADE
CUP6540Y22A
06/21/09
06/21/10
EACH OCCURRENCE
s4,000.000
AGGREGATE
s4,000,000
$
DEDUCTIBLE
$
X RETENTION $10000
C
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
34WEGPP3731
06/21/09
06/21/10
OTH-
X ITWOCRYSTWUfS
E.L. EACH ACCIDENT
$1,000,000
E.L. DISEASE -EA E MPLOYEEI
$1,000,000
E.L. DISEASE -POLICY LIMIT
$1,000,000
d
OTHER Professional
DPR9619054
06/21/09
06/21/10
$2,000,000 per claim
Liability
$5,000,000 annl aggr.
laims Made
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
*Except 10 days notice for non-payment of premium
RE: #P1027 Mason Transportation Corridor Trail Upgrade Separated Crossing
As required by written contract or written agreement, the Certificate Holder is included as Additional Insured under General
Liability with respect to the above referenced.
9,r_M 1 IrI1,A I r- 1'111JLUGPI I I AD D ITIONAL INSURED; INSURER LETTER: I:AIVGtLL.A I IUN
City of Fort Collins
215 N Mason St.,2nd Floor
PO Box 580
Fort Collins, CO 80522-0580
SHOULD ANYOF TH E ABOVE D ESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL30* DAYS WRITTEN
NOTICE TOTHE CERTIFICATE HOLDER NAM ED TOTH E LEFT, BUT FAILURE TODOSOSHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURERJTS AGENTS OR
REPRESENTATIVES.
A HORIZED REPRESENTATIV
AC:UHU 25-5 (7/97)1 of 2 #M569035 MOG 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.
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