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Home My WebLink About210366 GROWLING BEAR CO INC - INSURANCE CERTIFICATE (2)INSR ADDL SUBR LTR INSR WVD DATE (MM/DD/YYYY) PRODUCER CONTACT NAME: PHONE FAX (A/C, No, Ext): (A/C, No): E-MAIL ADDRESS: PRODUCER CUSTOMER ID #: INSURED INSURER A : INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER POLICY EFF POLICY EXP TYPE OF INSURANCE (MM/DD/YYYY) (MM/DD/YYYY) LIMITS GENERAL LIABILITY AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB WORKERS COMPENSATION AND EMPLOYERS' LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) AUTHORIZED REPRESENTATIVE INSURER(S) AFFORDING COVERAGE NAIC # Y / N N/A (Mandatory in NH) ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? EACH OCCURRENCE $ DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) $ CLAIMS-MADE OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ PRO- $ POLICY JECT LOC COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE (Per accident) $ HIRED AUTOS NON-OWNED AUTOS $ $ OCCUR EACH OCCURRENCE $ CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ AMS 25.3 (2009/09) DESCRIPTIONS (Continued from Page 1) City of Fort Collins and State of Colorad are included as Additional Insured as required by written contract with respects to liability arising out of work performed by the named insured. 2 of 2 #S803639/M803630 RETENTION $ $ WC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ c SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 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. 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). COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD O ACORDTM CERTIFICATE OF LIABILITY INSURANCE 06/24/2013 Flood & Peterson Ins., Inc. P. O. Box 578 Greeley, CO 80632 970 356-0123 Kim Parker 970 506-3213 970 506-6865 kparker@floodpeterson.com Growling Bear Co., Inc. 2330 4th Avenue Greeley, CO 80631-7113 Valley Forge Insurance Company Continental Casualty Company Pinnacol Assurance CNA Insurance Company A X X X PD Ded:1,000 X C2095216232 07/01/2013 07/01/2014 2,000,000 2,000,000 1,000,000 1,000,000 100,000 5,000 D X X X C2095216246 07/01/2013 07/01/2014 1,000,000 B X X X 10000 C2095216229 07/01/2013 07/01/2014 5,000,000 5,000,000 C 1436910 (Uninsured Contractors) 07/01/2013 07/01/2014 X 1,000,000 1,000,000 1,000,000 A Property C2095216232 07/01/2013 07/01/2014 Project: 7382 MAX BRT South Transit Center (See Attached Descriptions) City of Fort Collins P. O. Box 580 Fort Collins, CO 80522-0580 1 of 2 #S803639/M803630 Client#: 49185 GROBE2 KFP 1 of 2 #S803639/M803630