HomeMy WebLinkAbout478807 ABSOLUTE CAULKING & WATERPROOFING - INSURANCE CERTIFICATEACORD CERTIFICATE OF LIABILITY INSURANCE GP ID SF DATE IMM/OD VYYY)
ABSOL-2 04 29 11
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Forsberg Engerman Company HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
3575 S . Sherman St. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Englewood CO 80113
Phone:303-762-1717 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: Employers Mutual Casualty Co
Absolute" Caulking 6 INSURERB. - -
Watpperp_roofinty q Inggc, .Deering INSURERCPro:
11919 I-70 FHolrontaggeLRd N #112 INSURER D. - -
Wheat Ridge CO 80033
INSURER E
V 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.
LTR
NSR
TYPE OF INSURANCE
POLICY NUMBER
pATEYMMIDD/YY EFFECTIVE
PDA E LICYMMIDD/YY XPIRATI IT
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$1000000
PREMISES (Ea occurence)
$ 100000
A
X COMMERCIAL GENERAL LIABILITY
4D5179712
05/01/11
05/01/12
MED EXP(Any one person)
$ 5000
CLAIMS MADE 1XI OCCUR
PERSONAL B ADV INJURY
$1000000
GENERAL AGGREGATE
s 2000000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS-COMPIOP AGG
s2000000
JECTPOLICY X PRO- LOC
A
AUTOMOBILE
LIABILITY
ANYAUTD
4E5179712 -
05/01/11
05/01/12
COMBINED SINGLE LIMIT
(Ea accident)
$1000000
X
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULED AUTOS.:,
BODILY INJURY
(Per are
$
X
HIRED AUTOS
NON -OWNED AUTOS
X
PROPERTY DAMAGE'-
(Per. accident)
$
-
GARAGE LIABILITY
AUTO ONLY- EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
S
AUTO ONLY: AGG
EXCESSIUMBRELLA LIABILITY
EACH OCCURRENCE
s4000000
AGGREGATE
$4000000
A
X7 OCCUR cLAIMSMADE
4J5179712
05/01/11
05/01/12
$
DEDUCTIBLE
$
X RETENTION $10000
_WORKERS COMPENSATION AND
TORY LIMITS- I ER
_
_
E.L. EACH ACCIDENT
$
EMPLOYERS' LIABILITY
ANY PROPRIETORIPARTNERIEXECUTIVE
OFFICERIMEMBER EXCLUDED?
EL DISEASE - EA EMPLOYEE
$
E. L. DISEASE - POLICY LIMIT
$
If yes,desaibe under
SPECIAL PROVISIONS below
OTHER
A
Scheduled Equip
4C5179712 (1000 DE
) 05/01/11
05/01/12
$26600 Limit
A
Lease/Rented Equip
14C5179712 (1000 DE
) 05/01/11
O5/01/12
$350000 Limit
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
onAYC unl MOP CANCFI 1 ATKIN
CITYFOR
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 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
City of Fort Collins
PO BOX 580
REPRESENTATIVES.
AUT R REPRE NTATIVE
Ft Collins CO 80522-0580
ACORD 25 (2001108) - W ..wnv ....r.r..r..............
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.
29 Onnvosi