HomeMy WebLinkAbout110871 CLARK CONSTRUCTION - INSURANCE CERTIFICATEClient#: 21097
CLACO
ACORDTM CERTIFICATE OF LIABILITY INSURANCE
F DATE (MMDD 0 Y)
1/02/20
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. 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).
PRODUCER
Flood & Peterson Ins., Inc.
Corporate Mailing Address:
P. O. Box 578
NAME: Jennifer Winter
PHONE 970 266-7127 FAX 970 506-6846
A/C No Ext : A/C, No
E-MAIL
ADDRESS:
Greeley, CO 80632
CUSTOMER ID M
INSURER(S) AFFORDING COVERAGE
NAIC If
INSURED
INSURER A: The Cincinnati Insurance Compan
Clark Construction Co., Inc.
2956 Ginnala Drive
INSURER BPinnacol Assurance
Loveland, CO 80538
INSURER C :
INSURER D
INSURER E :
INSURER F :
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
L R 111-
TYPE OF INSURANCE
D
UBR
POLICY NUMBER
MM/DD/YYYY
MM/DD/YCY XYYY
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE Al OCCUR
KPD Ded:2,500
CPP1073940
CANCELLED
3/01/2010
11/01/2010
EACH OCCURRENCE
$1 000 000
DA AGE To
PREMIS
SES (E. olccur ence)
S500000
MED EXP (Any one person)
$5,000
PERSONAL& ADV INJURY
$1,000,000
GENERAL AGGREGATE
$2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
17 POLICY X JECT PRO LOC
PRODUCTS - COMP/OP AGG
$2,000,000
$
A
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
CPA1073940
CANCELLED
3/01/2010
11/01/2010
COMBINED SINGLE LIMIT
(Ea accident)
$1,000,000
X
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
X
X
$
UMBRELLA LIAB
EXCESS LIAB
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
$
AGGREGATE
$
DEDUCTIBLE
RETENTION
$
$
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVEY / N
OFFICER/MEMBER EXCLUDED? rN
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
N/A
4000003 _
4/01/2010
04/01/2011
X TWC ORYLI IT OH-
E.L. EACH ACCIDENT
s500,000
E.L. DISEASE - EA EMPLOYEE
s500,000
E.L. DISEASE - POLICY LIMIT
$500OOO
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
RE: Water's Way Neighborhood Park
City of Fort Collins is listed as an Additional Insured as their interest may appear as respects General
Liability. Insurance is primary and non-contributory.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS.
Purchasing Division
PO Box 580 AUTHORIZED REPRESENTATIVE
Fort Collins, CO 80522
01988-2009 ACORD CORPORATION. All rights reserved.
ACORD 25 (2009/09) 1 of 1 The ACORD name and logo are registered marks of ACORD
#S572157/M572147 JZS