HomeMy WebLinkAbout103009 PORTER INDUSTRIES INC - INSURANCE CERTIFICATE (16)q�p �R CERTIFICATE OF LIABILITY INSURANCE FRTE DATE (MM/DD,'1'1'1'1')
O-1 10/06/09
LBN Insurance Agcy-Johnstown
4848 Thompson Pkwy, Ste 200
Johnstown CO 80534
Phone:970-635-9400 Fax:970-635-9401
Porter Industries Inc.
Attn: Cheryl Kendrick
5202 Granite Street
Loveland CO 80537
COVERAGES
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 NAIC 9
INSURER The Hartford 00914
INSURER B Plnnacol Assurance 41190
INSURER C:
INSURER D:
INSURER 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.
LTR
SR
TYPE OF IN
POLICY NUMBER
DATE (MM/DDIYYYY)
DATE (MM/DD/YYYY)
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE Fx-1 OCCUR
X Blanket waiver
34UUNTX0464
04/30/09
04/30/10
EACH OCCURRENCE
$ 1, 000 , 000
PREMISES (Ea occurence)
$ 300,000
VIED EXP (Any one person)
$ 10,000
PERSONAL 8 ADV INJURY
$ 1 , 000 , 000
X
Blanket Add l 1 Ins
GENERAL AGGREGATE
s2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER
POLICY X PEo- LOC
PRODUCTS - COMP/OP AGG
s2,000,000
Emp Ben.
1,000,000
A
A
A
A
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
Blanket Waiver
34UUNTX0464
04/30/09
04/30/10
COMBINED SINGLE LIMIT
(Ea accident)
$ 1 , 000 , 000
X
BODILY INJURY
(Per person)
$
X
BODILY INJURY
(Per accident)
$
X
M
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
ANY AUTO
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
AUTO ONLY AGG
$
$
EXCESS I UMBRELLA LIABILITY
OCCUR ❑ CLAIMS MADE
DEDUCTIBLE
RETENTION $
EACH OCCURRENCE
$
AGGREGATE
$
$
$
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y I N
ANY PROPRIETOR/PARTNER/EXECUTIVE ❑
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH)
If yes, describe under
SPECIAL PROVISIONS below
4038253
07/01/09
07/01/10
WC LIMITS ER
X TOR
EL. 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 I LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
RE: Carpet Maintenance. If required by written contract or written
agreement, the certificate holder is included as additional insured for
ongoing operations under general liability.
CERTIFICATE HOLDER CANCELLATION
City of Fort Collins
Purchasing Division
PO Box 580
)Fort Collins CO 80522
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
CITYFC3 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
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
ACORD 25 (2009/01) 01988-2009 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
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
This Certificate of Insurance 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 (2009/01)