HomeMy WebLinkAboutMOLTZ CONSTRUCTION INC - INSURANCE CERTIFICATEF-
AC RQ CERTIFICATE OF LIABILITY INSURANCE
OATS4/20 1
03/2/2011
PRODUCER 1-303-534-4567
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
IMA of Colorado, Inc.
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
1550 17th Street
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Suite 600
Denver, CO 80202
INSURERS AFFORDING COVERAGE
INSURED
Molts Construction, Inc.
INSURERA:Nat'l Fire Ina Co Hartford (CNA
INSURERS: Continental Ins CO (CMA)
8807 CR 175
P O Box 729
INSURERC:Amer Cas CO of Reading, PA(CMA)
INSURER o: Pinnacol Assurance
Salida, CO 81201
NSURER 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.
INSR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTWE
DATE fMM1DD1YYI
POLICY EXPIRATION
DATE (MMIDDA'Y1
LIMITS
A
GENERAL LIABILITY
C2072560569
08/01/10
08/01/11
EACH OCCURRENCE
$1,000,000
FIRE DAMAGE (My orIefire)
$1,000,000
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE 7 OCCUR
MED EXP Any one mon)
$ 5, 000
PERSONAL&ADV INJURY
$ 1,000,000
X PD Ded:$5,000
GENERALAGGREGATE
,$2,000,000
GEN'L AGGREGATE
LIMIT APPLIES PER:
PRODUCTS - COMPIOP AGO
$2,000,000
POLICY
X PRO-
JPCT X LOC
B
AUTOMOBILE
X
LIABILITY
ANY AUTO
C2072534635
08/01/10
08/01/11
COMBINED SINGLE LIMIT
(Ea accident)
$1,000,000
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
X
BODILY INJURY
(Per eWdant)
$
HIRED AUTOS
NON -OWNED AUTOS
X
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
$
AUTO ONLY: AGO
C
EXCESS LIABILITY
C2072534683
08/01/10
08/01/11
EACH OCCURRENCE
$ 6,000,000
41 OCCUR 1:1CLAIMSMADE
AGGREGATE
$ 6,000,000
$
DEDUCTIBLE
$
X RETENTION $10,000
D
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
4059256
08/01/10
08/01/11
X I WCVSTALIM TUT- OTH-
R
E.L. EACH ACCIDENT
$ 500,000
E.L. DISEASE - EA EMPLOYE
§500, 000
E.L. DISEASE -POLICY LIMIT
$ 500, 000
OTHER
A
Stop Gap - Wyoming
C2072560569
08/01/10
08/01/11
Aggregate $ 1,000,000
Per Occurrence + 1,000,000
a
DESCRIPTION OF OPERATIONSAOCAUONSWEHICLESMXCLUSIONS ADDED BY ENDORE EMENTISPECIAL PROVISIONS _
City of Fort Collins, Engineer 6 Engineer's Consultants are included as Additional Insureds on the General, Automobile,
and Excess Liability Policies if required by written contract or agreement and with respect to work performed by Insure
subject to the policy terms and conditions. This Insurance is Primary and Non -Contributory on the General Liability
Policy subject to the policy terms and conditions.
Design/Construction Contractor.
City of Fort Collins
Financial Services, Purchasing Division
215 N. Mason St., 2nd Floor
PO Sox 580
Fort Collins, CO 80522
USA
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 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
25-S (7/97) francins
L
1988
F
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.
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