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Home My WebLink About168787 GOLDEN TRIANGLE CONSTRUCTION INC - INSURANCE CERTIFICATE (11)Cliei 51g2n Rr.rll IlTRl9 ACORDT,, CERTIFICATE OF LIABIL7Y INSURANCE DIYYYY) 09/11/69 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Willis of Colorado, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 720 South Colorado Boulevard HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, Suite 60ON Denver, CO 80246 INSURERS AFFORDING COVERAGE NAIC # INSURED Golden Triangle Construction, Inc. 700 Weaver Park Longmont, CO 80501 50 INSURERA. CNA Insurance Companies B6486 INSURERS Pinnacol Assurance 41190 INSURERC OneBeacon American Insurance Compan 20621 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. INSR LTR ADD'I INSRE TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE M IDDIYY POLICY EXPIRATION DATE IMMIDDIYY LIMITS A GENERAL LIABILITY TCP2022866738 12/31/08 12/31/09 EACHOCCURRFNCE X COMMERCIAL GENERALLIABILITI' _$1000000 DAA9AGEPREMISESORENTED gSOOOOO MED EXP (Any one person) $5 000 CLAIMS MADE a OCCUR PERSONAL & ADV INJURY $1 000 000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY JL JF CT n LOC PRODUCT S - COMPIOP AGO s2,000,000 A AUTOMOBILE LIABILITY ANY AUTO C2022866741 12/31/08 12/31/09 COMBINED SINGLE LIMIT Sa accitlenl) $1,000,000 X BODILY I (Per Person) S ALL OWNED AUTOS SCHEDULED AUTOS - X. Xs HIRED MIT OS NON -OWNED AUTOS BODILY INJURY (Per accitlenl) s PROPERTY DAMAGE (Per accitlenl) $ Physical Damage ACV less Ded GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHEEA ACC THAN S ANY AUTO $ AUTO ON AUTO ONLY'. AGO A EXCESSIUMBRELLA LIABILITY X OCCUR CLAIMS MADE CUP2022866786 12/31/08 12/31/09 EACH OCCURRENCE s7,000000 AGGREGATE s7,000,000 5 g DEDUCTIBLE $ X RETENi'ION $ 10 000 B WORKERS COMPENSATION AND 4013024 10/01/09 10/01/10 �' WC STATII- OTH- EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNEIVEXECUTIVE E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 OFFICERIMEMBER EXCLUDED? If yes, tlosRO antler S P SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $1,000,000 C OTHER Leased &/or 790015057 12/31/OS 12/31/09 $100,000 less Ded Rented Equipment Owned E ui ment ACV less Ded DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS This Certificate of Insurance represents coverage currently in effect and may or may not be in compliance with any written contract. The following cancellation conditions always apply: (See Attached Descriptions) City of Ft. Collins 215 N. Mason PO Box 580 Fort Collins, CO 80524 LD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL *In DAYS WRITTEN E TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL ;E NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR AUTH IZEU REPR[SENTATIVE ACORD 25 (2001111 of 3 #M647516 8NPER 0 ACORD CORPORATION 1988 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 (2001/08) 2 of 3 #M647516 DESCRIPTIONS (Continued from Page 1) - 10 days for non-payment of premium - If policy shown, 10 days for Workers' Compensation for fraud; material misrepresentation; non-payment of premium; other reasons approved by the Commissioner of Insurance AMS 25.3 (2001/08) 3 of 3 #M647516