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HomeMy WebLinkAboutL R CONTRACTING INC - INSURANCE CERTIFICATE (5)LRCON-1 OP ID: SJR , k. o CERTIFICATE OF LIABILITY INSURANCE �/� D0912212ATE 01 YT 09/2212014 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 WANED, 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 endorsements . PRODUCER CRS Insurance Brokerage Commercial Risk Solutions DBAINC.No CT Nathan M.Fonseca NAME PHONE FAX E, , 303-996-7801 INC, No: 303-757-7719 E-MAIL ADDRESS: 6600 E. Hampden Ave. Denver, CO 80224 Nathan M. Fonseca INSURER(Sl AFFORDING COVERAGE NAIL e INSURER A: Landmark Insurance Co. INSURED L R Contracting Inc. INSURERS:Pinnacol Assurance 10270 Rotherwood Circle Highlands Ranch, CO 80130 INSURER C: INSURER D : INSURER E: INSURER F: NO COVERAGE WITH CRS 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 T rypE OF INSURANCE SUBS POLICY NUMBER MADDL MIDOY EFF POLICY MMIDO UPLIMIT A X COMMERCUU-GENERALLIABRITY CLAIMS -MADE 1XI OCCUR LHA109868 09/2012014 09120/2016 EACH OCCURRENCE $ 1,000,00 PREMISES(Ea occurrence $ EXCLUDE MED EXP(My one person) $ EXCLUDE PERSONAL B ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PO- JETElLOC OTHER: GENERA -AGGREGATE $ 2,000,00 PRODUCTS - COMP/OP AGG $ 2,000,00 $ F AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS NO COVERAGE WITH CRS COMBINED SINGLE LIMIT Ea accident $ NI BODILY INJURY (Per Pa.) $ NI BODILY INJURY (Per accident) $ N1 PROPERTY DAMAGE Peracadem $ N/ $ F UMBRELLA LIAB EXCESS UAB OCCUR CI -AIMS -MADE NO COVERAGE WITH CRS EACH OCCURRENCE $ NI AGGREGATE $ N/ DED RETENTION f B WORKERS COMPENSATION AND EMPLOYERS' LIABILITYX ANY PROPRIETORIPARTNERIEXECUTNE YIN OFFICER/MEMBER EXCLUDED? (Mandatory In NH) DESCRIPTION OF OPERATIONS below NIA 161776 01/0112014 01/0112016 PER FT i' STATUTE ER E.L. EACH ACCIDENT $ 100,00 E.L. DI$EASE-EA EMPLOYEE $ 100,00 E.L. DISEASE -POLICY LIMIT E 500,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 1e1, Additional Remarks SLNedale, may be aeacbed If mom apace la nn,Wrad) All policy te=a, conditions and exclusions apply. CIFORTC City of Fort Collins P.O. Box 580 Fort Collins, CO 80526 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 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD