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Home My WebLink About130163 EMPIRE CARPENTRY - INSURANCE CERTIFICATE (2)10/22/2010 10:39 AM FROM: JCS TO: 9702216707 PAGE: 002 OF 003 ACORD�, CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNYYY) 10/22/2010 e PRODUCER (970) 484-2805 John C. Beckett &Associates, Inc. 220 Smith Street Ft. Collins CO 80524- 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 # INSURED Empire Carpentry, LLC P. 0. BOX 245 Bellvue CO 80512— INSURER A:ADDISON FARMERS INS CO INSURERB: INSURER INSURER D INSURERE: rnAil:Rel:Fc 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 DD'L INSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DDNY) POLICY EXPIRATION DATE (MMIDDNY) LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE Q OCCUR 60378006 10/30/2010 10/.30/2011 EACH OCCURRENCE 1,000,000 DAMAGE TO RENTED PREMISES Eeoccurrence $ 100,000 MED EXP (Any one person) S 5,000 PERSONAL &ADV INJURY $ 1,000,000 GENERAL AGGREGATE S 2 , OOO, 000 GEML AGGREGATE LIMIT APPLIES PER. POLICY X JECT X LOC PRODUCTS -COMP/OP AGG $ 2,000,000 EBLIA A AUTOMOBILE X X X LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OVVNEDAUTOS 60378006 _ 10/30/2010 10/30/2011 COMBINED SINGLE LIMIT (Ea acddent) $ 1,000,000 BODILY INJURY (Per person) S BODILY INJURY (Per acddent) $ . PROPERTY DAMAGE (Peracddent) GARAGE LIABILITY ANY AUTO NO COVERAGE AUTO ONLY - EAACCIDENT S OTHER THAN EA ACC AUTO ONLY: AGG S $ EXCESS/UMBRELLA LIABILITY OCCUR CLAIMS MADE DEDUCTIBLE - RETENTION $ NO COVERAGE EACH OCCURRENCE $ AGGREGATE S S g WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? It yes, describe under SPECIAL PROVISIONS below NO COVERAGE ' TORN!C STY LIMIff S ER ER E.L. EACH ACCIDENT S E.L. DISEASE - EA EMPLOYEE S E.L. DISEASE -POLICY LIMIT S OTHER NO COVERAGE DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS ( ) — (970) 221-6707 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE PURCHASING DEPT EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT CITY OF FORT amLINS FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON TIME PO BOW 580 INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE FORT COLLINS CO 80522- ACORU n IUU11UH) (9 ACORD CORPORATION 1988 INS025 (o f os).m Page 1 of 2 10/22/2010 10:39 AM FROM: JCS TO: 9702216707 PAGE: 003 OF 003 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. ACOR0 25 (2001108) INS025 (oio8ym AMS Page 2 of 2 10/22/2010 08:32:36 AM PINNACOL ASSURANCE PAGE 2 OF 3 ACORDTR CERTIFICATE OF LIABILITY INSURANCE DATE (MNY, l2010 O/22/2010 PRODUCER PINNACOL ASSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY 7501 E Lowry Blvd Denver, CO 80230-7006 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 NAIL# IN3URED EMPIRE CARPENTRY LLC INsuRERN PINNACOL ASSURANCE 41190 INSURER B: 521.5 SYCAMORE ST INSURER C: FORT COLLINS, CO 80521 INSURER D: INSURER E' COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDNG ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMMENT 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. INSR AOO'L POLICY EFFECTIVE POLICY EXPIRA71ON LTR IN8RO TYPE OFIN8URINCE POLICY NUMBER OATE(MMIDOIYYYY) DATE(MMIDDIYYYY) UMIT9 GENERAL LIABILITY EACH OCCURRENCE DAMAGE TO RENTED COMMERCIAL GENERAL LIABIU7Y CLAJMS MADE 11 OCCUR PREMISES MEO EXPpAxy one person) PERSONAL& ADV INJURY GENERALAGOREGATE GE NL AGGREGATE LIMIT AP PLIERS PER: PROOUCTB•COMPIOPAce POLICY 7 PROJECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO IEa Accident) BODILY INJURY ALLOW NEO AUTOS SCHEDULED AUTOS IPerperson) BODILY INJURY HIRED AUTOS NON -OWNED AUTOS IPeraccldent) PROPERTY DAMAGE (P er accldent) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT OTHER THAN EAACC ANYAUT4 AUTO ONLY: AGGl EXCESWUMBRELLA LIABILITY EACH OCCURRENCE AGGREGATE OCCUR 0 CLNMSMADE DEDUCTIBLE RETENTION 3 WORKERS COhPENSATIONANO x WC STATU- OTHER A EMPLOYER'S LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE 1519690 00/01/2010 09/01/2011 TORY LIMITS E.L FI,CHACCIDENT $100,000 OFFICERtMEMBER EXCLUDED! IlYes,please describe under SPECIAL PROJ1916N9 below —e.L DISEASE - EA EMPLOYEE $100,000 E.LOISEASE - POLICY LIMIT 500000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION 1268177 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE The City of Fort Collins THE EXPIRATION DATE THEREOF. THE ISSUING COMPANY WILL ENDEAVOR T Purchasing Division P O Box 580 MAIL 0 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR Fort Collins CO 80522 LIABILITY OFANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Charles Doggett ACORD 25(2001l08) Underwriter ACORD CORPORATION 198E 10/22/2010 08:32:36 AM PINNACOL ASSURANCE PAGE 3 OF 3 CERTIFICATE HOLDER COPY The City of Fort Collins Purchasing Division P O Box 580 Fort Collins CO 80522 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.