HomeMy WebLinkAbout441491 ALPINE DEMOLITION INC - INSURANCE CERTIFICATE (2)1212612012 17:03 ALPINE DEMOLITION (FAX)3039400868 P.002I002
AC<>RV* CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDOrMY)IMGM12
THO CESTIRGATE IS IsIUKD ABA MATTER OF INFORMATION ONLY AND CWMERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS GERI f"]. uuca rWl nrrlMm ilv—an
NEGATIVELYAMEND, EXTEND OR ALTER THS COVERAGE AFFORED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN
THE INSSWND SNSUREP4SXAUTHORIZED REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER.
IMP�WANT Ifeh.. r,.Atehdderlean AODITINPLINSURED,ttnpmi%les) must beendomed.ISUBR ATION IS WANED, subjcetmthetarme and condldonsoflhepalCYr
culAln poue;ea may Ie W. an and.hehmenl. AAteeement on ad cer6Ecsty dws he muter right, to the cerSRcete bolder In Ilea of such sadamemengs).
PRODUCER
Hackett Imwance Agency
8080 Ralston Road
CONTACT NAME:
EH7AML OPHEADDRESS: FAXIAA:,NA):
PRODUCER CUSTOMER 108
AtTnda, CO 80002
(303)450-8061 I �,
INSURERS AFFORDING COVERAGE
NAIC q
WEURED
INSURER A: Colony Irl9wanc2 Company
INSURER& 1y1'8I{SFDR lnoaranceC aDy
Alpine DEmo6tion, Inc.
INSURER C: Ameriaw Safety Risk
5790 W. 56m Ave C
ATvaJA, CO 80002
INSURER o-. Gmat American ITIs moe Compmr,
INSURER E:
COVERAGES CERTIFICATE NUMBER:
REVISION NUMBER:
THIS rc Tn CPPTIFYTHAT THE Pn1 ICIES nF INSURANCF IISTED BELOW HAVE BEEN ISSUED
TO THE INSURED NAMED ABOVE FOR THE POLICYPERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OFANY CONTRACT OR OTHER DOCUMENT WITH RESFECT TO WHICH THIS
CERTIFICATE MAY 13F 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.
Dt"R
TYPE OF INSURANCE
POLICY NUMBER
I PATS PCUCY(EFECTIVE r)
POUCYEXAT
OATBIMAPIRT103
LIMITS
A
X
®
OENERALUMBIL11Y
® COMMERICAL GENERAL LIABILITY
CLAM
®XC&U MADE ®OCCUR
—
GENT AGGREGATE LIMITAPPLIES PER:
POLICY® PROJECT
❑❑ LOC
GL951504
3-28.12
3-28.13
FAO1 CCCURENCE
$1
DAMAGETORE F..0
PREMISE& oowlmnca
SI
MED EXP(Any cna Psncn)
$!
PERSONA-& ADVINJURY
III
CENERALAGOREGATE
S7
PRODUCTS.COMp,L1PAGG
$i
❑ / IYMVW.UU LIRdILIIT
❑ ANY AUTO
❑ ALL OWNED AUTOS
❑ SCHEWLEDAUTOS
❑ HIREDAUTOS
F NON-OWNEOAUTOO
IBINED SINGlE L4AIT $
h Orsuncnee)
ILY INJURY $
pc,sm)
ILY INJURY $
DAMADE $
a
®
EXCESEMMBRELA LIABILITY
c(7BWa056212
8-]5-12
8-15-13
EACH OCCURRENCE
SIV,VUV,VUU
AGGREGATE
$ 10,000,000
® OCCUR ❑ CLAIMS MADE
❑ OEDUCTI&LE
® RETENTION $IO.000
S
$
❑
WORKED COMPENSATION AND EMPLOYERS'
OTK
❑ TOAYLIMITS ❑ ER
E.L,EACHACCIDENT
$
ANY PROPRIETOWARTNERtEXECU-TNE
CIFFICERIMEMBER EXCLUDED?
E.L. DISEASE. EA EMPLOYEE
—
$
tryeA,delLLYle9ander
&PEc1AL PROYI&ION&bolaw YIN
$
E.L. DISEASE -POLICY LIMIT
C
®
mTtER
ENV118323.1
&15.12
8-15-13
$5,D00,000
Pollution
Contractors Equipment
UAF336-d0-96-
1
11-13.12
11-13-13
$714,1300
03
$250D Ded.
DESCRIPTION OF OPERATIONS f LOCATIONS/ YEHICLEB) attach ACORD, 101, Addtltonal Remarks Scheoule, If mare apace to requlred)
CarSikab hddvr r addiflendl Inwred an d primory dud non•mntribulvry bvcc with weivsr or Hgh6 ardamartront when Tequirvd by oonbvot cud loss payee. The umbrcya liability
inswence shall apply on a'quote folloW nB form' basla to Mo underlying policies.
CERTIFICATE HOLDER CANCELLATION
SHOULOANYCF THE ABOVE DESCRIBED POLICIES 86 CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH
Ciy of Fort Collins
THE POLICY PROVIRIONB.
215 N Mason Street
FT Collins, CO 80520
AUTNOR12EB/tFS ESENTATNE