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Home My WebLink About109256 BARKER CONSTRUCTION COMPANY INC - INSURANCE CERTIFICATEFAX TRANSMITTAL SHEET ATTN: FROM: City of Fort Collins Flood and Peterson Insurance COMPANY: DATE: 9/27/2012 4:50:12 PM FAX NUMBER: SENDER FAX NUMBER: 9702216707 (970)330-1867 # OF PAGES INC. COVER: SENDER PHONE NUMBER: 3 (970) 356-0123 NOTES/COMMENTS: Please see attached documents The contents of this message sent from Flood & Peterson Insurance, Inc. is confidential, possibly privileged, and intended only for its addressee. If you have received this message in error, you must not disclose, copy, circulate, or in any other way use or rely on the information contained in this message. If you have received this message in error, please contact Flood & Peterson Insurance, Inc. by phone at 970-356-0123. Client#: 20175 BARCO ACORDTM CERTIFICATE OF LIABILITY INSURANCE DYY) 09/27/2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. 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). PRODUCER Flood & Peterson Ins., Inc. CONTACTBrianne Danielson NAME: PA/C HONEo 970 266-7118 FAX 970 506-6846 NEz1: (A/C, No): P. O. Box 578 Greeley, CO 80632 970 356-0123 ADDRIESS. Brianne.Danielson@floodandpeterson.com PRODUCER CUSTOMER ID#: INSURER(S) AFFORDING COVERAGE NAIC# INSURED Barker Construction Company, Inc. 142 North Timberline Road INSURER A. Bituminous Insurance INSURER B Pinnacol Assurance Fort Collins, CO 80524 INSURER C INSURER D INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE %DDI_3LBR NSR NVD POLICY NUMBER POLICY EFF MM/DD/VVVV POLICY EXP MM/DD/VVVV LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMSMADE4OCCUR X PDDed:1,000 CLP3570097 5/01/2012 05/01/2013 EACH OCCURRENCE $1,0005000 DAMAGE TO RENTED PREMSES(Ea occurrence) $3005000 MED EXP(Any one person) $105000 PERSONAL& ADV INJURY $150005000 GENERAL AGGREGATE $2,000,000 GENL AGGREGATE LIMIT APPLIES PER POLICYF_X1 PRO LOG PRODUCTS-COMP/OP AGO $2,000,000 $ A AUTOMOBILE LIABILITY ANVAUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NONOWNEDAUTOS Drive Other Car CAP3570098 5/01/2012 05/01/2013 COMBINED SINGLE LIMIT (Ea accident) $1000000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ X PROPERTY DAMAGE (Per accident) $ X X $ X $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMSMADEAGGREGATE EACH OCCURRENCE $ $ DEDUCTIBLE RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITYYIN ANY PROP RI ETO R/PARTNER/EXECUTIVE 7 OFFICER/MEMBER EXCLUDED' (Mandatory in NH) 1 yes, describe under DESCRIPTION OF OPERATIONS below N/A I 4033353 I 10/01/2012 10/01/201 X WCSTATU- OTH- TORV LIMITS ER E L. EACH ACCIDENT $150005000 E. L. DISEASEEAEMPLOYEE $150005000 EL.DISEASE -POLICY LIMIT $1,0005000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more space is required) City of Fort Collins is listed as an Additional Insured as their interest may appear as respects General Liability. Insurance is primary and non-contributory. City of Fort Collins Purchasing DepartmentAttn: James O'Neil PO Box 580 Ft Collins, CO 80522 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE �eF.rera�lL� ACORD 25 (2009/09) 1 of 1 #S738852/M738843 01988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD JZS Page This page has been left blank intentionally.