HomeMy WebLinkAboutPINKARD CONSTRUCTION - INSURANCE CERTIFICATE (5)F
ACORIZ CERTIFICATE OF LIABILITY INSURANCE 1/02 M,DDIYI)
11/02/09
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
Pinkard Construction
9195 West 6th Avenue
Lakewood, CO 80215
COVERAGES
INSURER A: Travelers Indemnity Co. of America
INSURER B: Travelers Property Casualty Co of America
INSURER C:National Union Fire Ins. Co. of PA (AIG)
INSURERD:Pinnacol Assurance
INSURER E: Illinois Union Ins Co (ACE American Ins C
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 IMMIDDIYY)
POLICY EXPIRATION
DATE (MM/DD/YYI
LIMITS
A
GENERAL LIABILITY
DTC00084P262IND09
11/01/09
11/01/10
EACH OCCURRENCE
$1,000,000
FIRE DAMAGE (Any one fire)
$ 300 , 000
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE FKOCCUR
MED EXP Any one person
$ 5 , 000
PERSONAL & ADV INJURY
$ 1 , 000 , 000
GENERAL AGGREGATE
$ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
$ 2 , 000 , 000
17 POLICY X PRO LOC
B
AUTOMOBILE
LIABILITY
ANY AUTO
DT8100084P262TIL09
11/01/09
11/01/10
COMBINED SINGLE LIMIT
(Ea accident)
$ 1, 000, 000
X
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
X
X
BODILY INJURY
(Per accident)
$
HIRED AUTOS
NON -OWNED AUTOS
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
$
AUTO ONLY: AGG
C
EXCESS LIABILITY
BE23465039
11/01/09
11/01/10
EACH OCCURRENCE
$1,000,000
X OCCUR CLAIMS MADE
AGGREGATE
$ 1,000,000
$
$
DEDUCTIBLE
$
X RETENTION $10 , 000
D
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
2321400
10/01/09
10/01/10
TAT
X WCSLIMI- OR
LIM T
E.L. EACH ACCIDENT
$ 500 , 000
E.L. DISEASE - EA EMPLOYEE
$ 500 , 000
E.L. DISEASE - POLICY LIMIT
1500,000
OTHER
E
Combination
CEOG23567519005
11/01/09
11/01/10
Deductible $ 25,000
Professional 6 Pollution
Per Claim $ 2,000,000
Coverage iClaims
Made
lAggregate
s 2,000,000
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
City of Fort Collins, Colorado 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.
GtK I IFIGA I t MULUtK I I ADDITIONAL INSURED; INSURER LETTER: GANGtLLATIUN
RE: CONSTRUCTION OF A 49,980 SQ . FT. NORTBSIDE AZTLAN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
CENTER LOCATED AT 112 EAST WILLOW STREET, FORT COLLINS, CO
City of Fort Collins, Colorado 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
215 North Mason Street, 2nd Floor IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
PO BOX 580 REPRESENTATIVES.
Fort Collins, CO 80522 r6�
TEPRESENTATIVE
USA (/
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At;UKU ZO-b (//9/) hollyll
13532172
L Certificate Delivery by CertificatesNow - www.ConfirmNet.com - 877.669.8600
O ACORD CORPORATION 1988
F
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)
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