HomeMy WebLinkAbout101127 4-K PAINTING AND DRYWALL INC - INSURANCE CERTIFICATE (7)7 ® DATE (MM/DD/YYYY)
'4� CERTIFICATE OF LIABILITY INSURANCE 8/20/2010
PRODUCER (970) 223-0924 FAX: (970) 267-2231 THIS CERTIFICATE IS ISSUED:AS A'MATTER OF INFORMATION
Colorado BW Insurance Agency; Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
1075 W Horsetooth Rd, Ste 106 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Fort Collins CO 80526 INSURERS AFFORDING COVERAGE:; NAIC #
INSURED INSURER A: Continental Western Group
4K Painting &,.Drywall, Inc. INSURER B: Pinnacol Assurance ;. 41190
` 2900 Galway INSURER C:
INSURER D:
,Laporte, CO 80535 INSURERE:
rnvconr_ce
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTAN DING
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 ADD'L INSRD
TYPE OF INS RANCE
POLICY NUMBER
POLICY EFFECTIVE
POLICY EXPIRATIONLTR
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
DAMAGE TO RENTED
PREMISES (Ea occurrence )
$ 250,000
X COMMERCIAL GENERAL LIABILITY
A
— CLAIMS MADE X OCCUR
CWP270615824
7/23/2010
7/23/2011
MED EXP (Any one person)
$ 5,000
PERSONAL 8 ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
$ 2,000,000
X POLICY n PRO-JECT LOC
AUTOMOBILE
LIABILITY
ANY AUTO � " - '
... ..... .... -
-
COMBINED SINGLE LIMIT.
(Ea accident)
$ 11000,000
BODILY INJURY
(Per person)
$
A
.•
ALL OWNED AUTOS "'
SCHEDULED AUTOS
CWP270615824
08/11/2010
7/23/2011
X
X
BODILY INJURY
(Per accident)
I'
HIRED AUTOS
NON -OWNED AUTOS
� ' ' ''
- . • - ,
X
'
PROPERTY DAMAGE..
(Per accident)
$
GARAGE LIABILITY
-AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$ '
ANY AUTO
-
$
_
AUTO ONLY: AGG
EXCESS I UMBRELLA LIABILITY
-
EACH OCCURRENCE
$ 2,000,000
AGGREGATE
$
OCCUR F-I CLAIMS MADE
"" "
$
$
A
_ DEDUCTIBLE
CU2892474-20
08/11/2010
7/23/2011
$
RETENTION $
B
WORKERS COMPENSATION
AND EMPLOYERS' L!ABIUTY
ANY PROPRIETOR/PARTNER/EXECUTIVE �
I
— WC STATU- OTH--
E.L. EACH ACCIDENT
Is - 500,000
E.L. DISEASE - EA EMPLOYE
$ 500,000
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
4080430
7/1/2010
7/1/2011
E.L. DISEASE - POLICY LIMIT
I $ 500,000
If yes, describe under
SPECIAL PROVISIONS below
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
The certificate holder is named as an Additional Insured with respect to the ongoing operations of the Named Insured
on the General Liability only.
GtK I It-IGA I t NULUtK ii A1Vl+CLLN I I%JN
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of Fort Collins DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
Purchasing Department NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
PO BOX 580
Fort Collins, CO 80522 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
Amon ,7s /,7nno/ni%
n 1988-2nn9 ACORD CORPORATION. All rights reserved.
INS025 (2009o1) 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)
INS025 (200901)