HomeMy WebLinkAboutHALL IRWIN CORPORATION - INSURANCE CERTIFICATEClient#: 44870
HALIRI
ACORD- CERTIFICATE OF LIABILITY INSURANCE
1ti30/09D,YYYY)
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Flood & Peterson Ins. Inc.
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
P. O. Box 578
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
4687 W. 18th Street
Greeley, CO 80632
INSURERS AFFORDING COVERAGE
NAIC #
INSURED
HALL IRWIN CORPORATION
Attn: Accounts Payable
301 Centennial Dr
Milliken, CO 80543-3222
INSURER A: Travelers Insurance Company
INSURER B: Pinnacol Assurance
INSURER C:
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.
LTR
NSR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE MWDD/VY
POLICY EXPIRATION
DATE MWDD/YV
LIMITS
A
GENERAL LIABILITY
DTC07212M7431ND09
12/31/09
12/31/10
EACH OCCURRENCE
$1 000 000
X COMMERCIAL GENERAL LIABILITY
DAMAGE TO RENTEDPREMISES (E.
$300 000
CLAIMS MADE Ex —]OCCUR
MED EXP (Any one person)
$10 000
PERSONAL & ADV INJURY
$1 000 000
X PC Ded:5,000
GENERAL AGGREGATE
s2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
s2,000,000
POLICY X PROECT El LOC
J
A
AUTOMOBILE LIABILITY
X ANY AUTO
DT8107212M743TIL09
12/31/09
12/31/10
COMBINED SINGLE LIMIT
(Ea accident)
$1,000,000
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY
(Per accident)
$
X HIRED AUTOS
X NON -OWNED AUTOS
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
$
AUTO ONLY: AGG
A
EXCESS/UMBRELLA LIABILITY
DTSMCUP7212M743TIL
12/31/09
12/31/10
EACH OCCURRENCE
s5,000,000
X OCCUR CLAIMS MADE
AGGREGATE
s5,000,000
$
DEDUCTIBLE
$
X RETENTION $ 0 -
-
-- -
B
WORKERS COMPENSATION AND
4021105
01/01/10
01/01/11
X WC SLIMIT ER
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
E.L. EACH ACCIDENT
$500 000
E.L. DISEASE - EA EMPLOYEE
$500 000
OFFICER/MEMBER EXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE - POLICY LIMIT
$500 000
A
OTHER Equipment
QT66099OX1144TIL10
01/01/10
01/01/11
Blanket Limit
Deductible $5,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
Certificate holder is added as an additional insured.
City of Fort Collins
P. 0. Box 580
Fort Collins, CO 80522-0580
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 'A()_ 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
AUTHORIZED REPRESENTATIVE
ACORD 25 (2001/08) 1 of 2 #S497387/M495579 KFP o 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 (2001/08) 2 of 2 #S497387/M495579