HomeMy WebLinkAbout467727 DRAHOTA COMMERCIAL LLC - INSURANCE CERTIFICATE (8)ACORDn, CERTIFICATE OF LIABILITY INSURANCE 7/1i2011
DATE (MM/DD/YYYY)
11/30/2010
PRODUCER Lockton Companies, LLC Denver
8110 E Union Avenue
Suite 700
Denver CO 80237
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
NAIC #
(303) 414-6000
INSURED Drahota Commercial, LLC
INSURER A: Zurich American Insurance
1054659 PO Box 272269
Fort Collins, CO 80527
INSURER B : Pinnacol Assurance
INSURER c : Navigators Insurance Company
42307
INSURER D :
INSURER E:
COVERAGES ))RAC001 uX THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING
INSI IRFR/R1 AIITI4nR17Fn RFPRFRFNTATIVF OR PRODt1CFR AND THE CERTIFICATE HOLDER.
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'L
INSRD
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE (MM/DD/YY)
POLICY EXPIRATION
DATE (MM/DD/YY)
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$ 1 000 000
DAMAGE TO RENTED
P E - Ea occurence
f1
$ 300,000
A
X COMMERCIAL GENERAL LIABILITY
CP0375796407
12/1/2010
12/l/2011
MED EXP (Any one person)
$ 10,000
CLAIMS MADE FRI OCCUR
PERSONAL & ADV INJURY
$ -11000,000
GENERAL AGGREGATE
$ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
$ 2,000,000
PRO -
POLICY X JECT X LOC
A
AUTOMOBILE
LIABILITY
ANY AUTO
CP0375796407
12/1/2010
12/l/2011
COMBINED SINGLE LIMIT
(Ea accident)
$ 1,000,000
X
BODILY INJURY
(Per person)
$ XXXXXXX
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY
(Per accident)
$ XXXXXXX
HIRED AUTOS
NON -OWNED AUTOS
PROPERTY DAMAGE
(Per accident)
$ XXXXXXX
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$ XXXXXXX
OTHER THAN EA ACC
$ XXXXXXX
ANY AUTO
NOT APPLICABLE
$ XXXXXXX
AUTO ONLY: AGG
C
EXCESS/UMBRELLA LIABILITY
X OCCUR CLAIMS MADE
SEl0EXC7196$$IV
12/I/2010
12/1/2011
EACH OCCURRENCE
$ 5,000,000
AGGREGATE
$ 5,000,000
$ XXXXXXX
UMBRELLA
El
$ XXXXXXX
FORM
DEDUCTIBLE
$ XXXXXXX
RETENTION $
B
WORKERS COMPENSATION AND
2286970
7/1,12010
7/l/201 1
X WC STATU- I OTH-
EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE �
E.L. EACH ACCIDENT
$ 1,000,000
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
If yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
P1123 General Contractor for Fire Station Expansion and Renovation Projects.
3636645 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
Financial Services - Purchasing Division NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
215 N. Mason Street, 2nd Floor IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
P.O. Box 580
Fort Collins, CO 80522 REPRESENTATIVES.
AUTHORIZED REPRESE
ACORn 25 120n9/011
ACORD CORPORATION. All rights reserved
The ACORD name and logo are registered marks of ACORD
Fnr n,,e.,ti,n, ranardinn this c ftiltatr_ enntaet the member lie ed in the 'Prn niter' sertinn ahnve and enmity the client rnde 'nRAC001'.