HomeMy WebLinkAbout441491 ALPINE DEMOLITION INC - INSURANCE CERTIFICATE�ccaizn
CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 0$/2aH2
NEGATIVELY AMEND,
Hackett Insurance Agency
8080 Ralston Road
Arvada, CO 80002
(303)420-8061
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Alpine Demolition, Inc.
5790 W. 56c Ave C
Arvada, CO 80002
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AFFORED BY THE POLICIES BELOW. THIS CERTIFICATE OF
/E OR PRODUCER AND THE CERTIFICATE HOLDER
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CONTACT NAME:
PHONE (A/C, No): FAX (A/C, No):
E-MAIL ADDRESS:
PRODUCER CUSTOMER ADC
INSURERS AFFORDING COVERAGE
INSURER A
Colony Insurance Company
INSURER B:
Evanston Insurance Company
INSURER C:
American Safety Risk
INSURER D:
Great American Insurance Col
INSURER E:
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,
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TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE (MWDDrrf)
POLICY EXPIRATION
DATE (MWDD/1'Y)
LIMITS
A
X
®
GENERAL LIABILITY
® COMMERICAL GENERAL LIABILITY
❑❑CLAIMS MADE ®OCCUR
GL951504
3-28-12
3-29-13
EACH OCCURENCE
$1,000,000
DAMAGE TO RENTED
PREMISES Ea ooarnence
$100,000
MED EXP(My one person)
$5_000
®XC&U
PERSONAL S ADV INJURY
$1,000,000
❑ —
GENERAL AGGREGATE
$2,000,000
GEH L AGGREGATE LIMIT APPLIES PER:
❑ POLICY ® PROJECT ❑ LOC
PRODUCTS -COMP/OP AGG
E2,000,000
El❑ANY
AUTOMOBILE LIABILITY
AUTO
COMBINED SINGLE LIMB
(Each Occurrence)
$
BODILY INJURY
(Par Parecn)
$
❑ ALL OWNED AUTOS
❑ SCHEDULED AUTOS
BODILY INJURY
(Per ao7tlent)
$
❑ HIRED AUTOS
❑ NON-OMED AUTOS
PROPERTY DAMAGE
(Per accident)
$
❑ —
B
®
EXCESS(UMBRELLA LIABILITY
® OCCUR ❑CLAIMS MADE
CUB W357701 I
8-I S-I l
8-I 5-12
EACH OCCURRENCE
$ 10,000,000
AGGREGATE
$ 10,000,000
E
❑ DEDUCTIBLE
® RETENTION $1 0000
E
$
❑
WORKERS COMPENSATION AND EMPLOYERS'
LIABILITY
❑ WC
TORY LIMITS ❑ T
E.L. EACH ACCIDENT
$
ANY PROPRIETOR/PARTNER/EXECU-TIVE
OFFICER/MEMBER EXCLUDED?
If yea, describe uncer
E.L. DISEASE - EA EMPLOYEE
$
SPECIAL PROVISIONS halos YIN
E.L. DISEASE -POLICY LIMB
$
C
®
OTHER
Pollution
Contractors Equipment
PPL0203801104
IMP836-40-96-
B-IS-II
11-13-11
B-IS-l2
11-13-12
E5,000,000
$714,000
02
$2500 Ded.
DESCRIPTION OF OPERATIONS I LOCATION& VEHICLES I attach ACORD, 101, Additional Remarks Schedule, H more space Is required)
Certificate holder is additional insured on a primary and noncontributory basis with waiver
of rights endorsement when required by Contract and loss payee. The umbrella liability
insurance shall apply on a'quote following form' basis to the underlying policies.
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
City of Fort Collins
EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH
300 La Port Ave
THE POLICY PROVISIONS.
Fort Collins, CO 80524
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