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HomeMy WebLinkAbout109256 BARKER CONSTRUCTION - INSURANCE CERTIFICATEOP ID: PO ACORO CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY) 04/17/2015 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 PFS Insurance Group - DV 7200 S Alton Way, Ste A-140 Centennial, CO 80112 Jim Olafson CONTACT Jim Olafson NAME: PHONE FAX AIC E#: A/C No E-MAIL L ADDRESS: PRODUCER gARKE-5 C STOMER ID #: INSURERS AFFORDING COVERAGE NAIC # INSURED Barker Construction Co. Inc. 142 North Timberline INSURERA: EMC Insurance Companies 21415 INSURER B: Pinnacol Assurance Co 41190 INSURER C : Fort Collins, CO 80524 INSURER D INSURER E : INSURER F : r,clll\I \II IaaDCD• COVERAGES GtKIIrIGAItNUIVIDCIc: BELOW HAVE BEEN ISSUED TO THE INSURED — NAMED ABOVE FOR THE POLICY PERIOD THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN ADDL UB POLICY EFF POLICY EXP TYPE OF INSURANCE POLICY NUMBER MM/DDIYYYY MM/DD/YYYY LIMITS LTR EACH OCCURRENCE $ 1,000,00 GENERAL LIABILITY 5DE11458 05/01/2015 05101/2016 A ET RE PREMISES Ea occurrence $ 300,00 A GENERAL LIABILITY 5,00 MED EXP (Any one person) $ TXCOMMERCIAL CLAIMS -MADE O OCCUR PERSONAL B ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 PRODUCTS -COMP/OP AGG $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: $ PRO n LOG X POLICY 7 COMBINED SINGLE LIMIT $ 1,000,00 AUTOMOBILE LIABILITY (Ea accident) A ANY AUTO 5E11458 OS/01/2015 05/01/2016 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ ALL OWNED AUTOS PROPERTY DAMAGE $ SCHEDULED AUTOS (PERACCIDENTIX) HIRED AUTOS NON-OWNEDAUTOS X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,00 AGGREGATE 1,000,00 EXCESS LIAB CLAIMS -MADE SJ11458 05/01/2015 05/01/2015 $ DEDUCTIBLE X RETENTION $ 10000 X WC STI O R I E $ WORKERS COMPENSATION E.L. EACH ACCIDENT $ 1,000,00 AND EMPLOYERS' LIABILITY YIN 403353 10/01/2014 10/01/2015 B ANY PROPRIETORIPARTNER/EXECUTIVE ❑ NIA A 1,000,00 OFFICERWEMBER EXCLUDED? (Mandatory in NH) If yes, describe under E.L. DISEASE-EAEMPLOYEE $ E. L. DISEASE - POLICY LIMIT $ 1000,00 , DESCRIPTION OF OPERATIONS below 5C11458 05/0112015 OS/01/2016 Lease 3100,00 A Equipment Floater anyone 150,00 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) If regired by written agreement, the certificate holder is included as liability and additional insured for ongoing operations under general liability (except hired and non -owned designatedunder ices 20bile uto obile)nsu insured City of Fort Collins John Stephen, CPPO,LEED AP 215 N. Mason Fort Collins, CO 80522 CITYFC1 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 Jim Olafson ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD OP ID: PO CERTIFICATE OF LIABILITY INSURANCE D04/171201ATE YV) 04/17/2015 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 PFS Insurance Group - DV 7200 S Alton Way, Ste A-140 Centennial, CO 80112 Jim Olafson CONT NAMEACT: Jim Olafson PHONE FA% A/C No Ext : A/C No), E-MAIL ADDRESS: PRODUCER gARKE-5 CUST MER ID#: INSURERS AFFORDING COVERAGE NAIL # INSURED Barker Construction CO.InC. 142 North Timberline INSURERA:EMCInsurance Companies 21415 INSURER B: Pinnacol Assurance Co 41190 INSURER C: Fort Collins, CO 80524 INSURER D: INSURER E : INSURER F : COVERAGES t nm I Iri%,A I c: murrlor.n. --------- ----- 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. IN LTR rX TYPE OF INSURANCE NERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR A DL SUe POLICY NUMBER SDE11458 POLICY EFF MMIDDIYYYY 05/01/2015 POLICY EXP MM/DD/YYYY 05/01/2016 LIMITS EACH OCCURRENCE $ 1,000,00 ET PREMISES Ea occurrence) PREMDAMTISES $ 300,00 MED EXP (Any one person) $ 5,0U PERSONAL B ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 PRODUCTS - COMP/OP AGG $ 2,000,00 N'L AGGREGATE LIMIT APPLIES PER: POLICYPRO- zcTLOC $ A AUTOMOBILE LIABILITY ANY AUTO 5E11458 05/01I2015 05/01/2016 COMBINED SINGLE LIMIT (Ea accident) $ 1 000 00 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ ALL OWNED AUTOS PROPERTY DAMAGE (PERACCIDENT) $ SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS X X X UMBRELLALUIB EXCESS LIAB OCCUR CLAIMS -MADE SJ11458 05/01/2015 05/01/2015 EACH OCCURRENCE $ 1,000,00 AGGREGATE $ 1,000,00 $ DEDUCTIBLE X WC STATUT gy - DER $ X RETENTION $ 10000 WORKERS COMPENSATION E.L. EACH ACCIDENT $ 1,000,00 B q AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? (Mandatory in NH) It yes. describe under DESCRIPTION OF OPERATIONS below Equipment Floater NIA 403353 5C11458 10/01/2014 05/01/2015 10/01/2015 05/01/2016 E.L. DISEASE - EA EMPLOYEE $ 1,000,00 E.L. DISEASE - POLICY LIMIT Lease/Ren anyone $ 1,000,00 300,00 150,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) If required by written agreement, the certificate holder is included as additional insured on a prima. and non-contributory basis for ongoing operations under general liability. City of Fort Collins Purchasing Dept. Attn: James O'Neil P.O. Box 580 Fort Collins, CO 80 CITYFCI 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 Jim Olafson ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD OP ID: PO A CERTIFICATE OF LIABILITY INSURANCE DATE 7/2015Y) 04/17/2015 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). PFS Insurance Group - DV 7200 S Alton Way, Ste A-140 Centennial, CO 80112 Jim Olafson CONTAPRODUCER NAME: Jim Olafson PHONE FAX Ext A C No E-MAILo ADDRESS: PRODUCER gARKE-5 CU TOMER ID a: INSURERS AFFORDING COVERAGE NAIC # INSURED Barker Construction Co. Inc. 142 North Timberline Fort Collins, CO 80524 INSURER A: EMC Insurance Companies 21415 INSURERB: Pinnacol Assurance Co 41190 INSURERC: INSURER D : INSURER E : INSURER F : 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. INS" LTR TYPE OF INSURANCE DL POLICY NUMBER MMIDDYYYYYI IMMIDDIYYYYI LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 PREMISES Ea occurrence $ 300,00 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FXI OCCUR 5DE11458 05/01/2016 05/01/2016 MED EXP (Any one person) $ 5,00 PERSONAL$ ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,00 $ X1 POLICY PRO LOC A AUTOMOBILE LIABILITY ANY AUTO SE11458 05/01/2015 05/01/2016 COMBINED SINGLE LIMIT i $ 1,000,00 X INJURY BODILY NJURY (Per person) BODILY $ BODILY INJURY (Per accident) $ ALL OWNED AUTOS PROPERTY DAMAGE (PER ACCIDENT) $ SCHEDULED AUTOS HIRED AUTOS X X $ NON -OWNED AUTOS X UMBRELLA LIAR EXCESS LIAR OCCUR CLAIMS -MADE SJ11458 05/01/2015 05/01/2015 EACH OCCURRENCE $ 1,000,00 AGGREGATE $ 1,000,00 DEDUCTIBLE $ STATU- O R X TWO $ X O$ 10000 WORKERS COMPENSATION B AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER/EXECUTNE YIN 03353 10/01/2014 10/01/2015 E.LEACHACCIDENT $ 1,000,00 E.L DISEASE - EA EMPLOYEE $ 1,000,00 A OFFICERIMEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below Equipment Floater NIA SC11458 05/01/2015 05/01/2016 E.L. DISEASE - POLICY LIMIT $ 1,000,00 Lease/Ren 300,00 anyone 150,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) If required by written agreement, the certificate holder is included as additional insured on a prima- and non-contributory basis for ongoing operations under general Iiab�ty. CITYFC1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Fort Collins Engineering Dept. AUTHORIZED REPRESENTATIVE P.O. Box 580 Jim Olafson Fort Collins, CO 80522 hl Ivoo-GUVD H�Vmu ru „V.I L. Iw.IJ ... ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD OP ID: PO CERTIFICATE OF LIABILITY INSURANCE D041m1712MIDYYYY) 4/7/2015 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 PFS Insurance Group - DV 7200 S Alton Way, Ste A-140 Centennial, CO 80112 Jim Olafson Co NT NAEACT MJim Olafson PHONE FAX A/C No Er : JAIC. No), E-MAIL ADDRESS: PROD MCER gARKE 5 CUSTOE ID INSURERS AFFORDING COVERAGE NAIC # INSURED Barker Construction Co. Inc. 142 North Timberline Fort Collins, CO 80524 INSURER A;EMC Insurance Companies 21415 INSURERB: Pirmacol Assurance Co 41190 INSURERC: INSURER D : INSURER E : INSURER F 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 I LTR TYPE OF INSURANCE ADDL B POLICY NUMBER MM/DDPOLICYfYYYY MMLDD/YYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Fx-1 OCCUR 5DE11458 05/01/2015 05/01/2016 EACH OCCURRENCE $ 1,000,00 DAMAGE TO RENED PREMISES Ea ocou en $ 300,00 MED EXP (Any one person) $ 5,00 PERSONAL & ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,00 $ X POLICY PRO LOC A AUTOMOBILE LIABILITY ANY AUTO 5E11458 05/01/2015 05/01/2016 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,00 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ ALL OWNED AUTOS PROPERTY DAMAGE (PER ACCIDENT) $ SCHEDULED AUTOS HIRED AUTOS X X $ NON -OWNED AUTOS X UMBRELLA LIAB EXCESS LIAR OCCUR CLAIMS -MADE 5J11458 05/01/2015 05/01/2015 EACH OCCURRENCE $ 1,000,00 AGGREGATE $ 1,000,00 DEDUCTIBLE $ X $ RETENTION $ 10000 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTNE Y OFFICERIMEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A 403353 10101/2014 10/01/2015 X WC STATUS R FIR E.L. EACH $ 1,000,00 E.L. DISEASE - EA EMPLOYE $ 1,000,00 E.L. DISEASE -POLICY LIMIT $ 1,000,00 A Equipment Floater SC11458 06/01/2015 06/01/2016 Lease/Ren 300,00 anyone 150,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) License DM-374 CITYFC1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Fort Collins Neighborhood Sr Building AUTHORIZED REPRESENTATIVE Services Jim Olafson P.O. Box 580 ll 1V00-4VVU MI VI\u vvFXF v"M..vn, nu.,y uw. coc..--. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD OP ID: PO i 1 CERTIFICATE OF LIABILITY INSURANCE DATE 04,ml7/201MIDDIYYY) 04/17/2015 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 PFS Insurance Group - DV 7200 S Alton Way, Ste A-140 Centennial, CO 80112 Jim Olafson CONTACT NAME: .11m Olafson PHONE FAX A/C Ext : A/C, No AE-MAILL ADDRESS: PROD0MEUCERR1 #: BARKE-5 CUS7 INSURERS AFFORDING COVERAGE NAIC If INSURED Barker COnStrUCtlOn CO. InC. 142 North Timberline INSURERA:EMC Insurance Companies 21415 INSURER B: Pinnacol Assurance Co 41190 INSURER C : Fort Collins, CO 80524 INSURER D INSURER E: INSURER F COVERAGES t r-m I it R.m i c mulno�n. ----------- -- ------ 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. IL R A TYPE OF INSURANCE GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS-N1ADE a OCCUR ADDL B POLICY NUMBER 5DE11458 POLICY EFF MM/DDIYYYY 05/01/2015 POLICY EXP MMIDD/YYYY 05/0112016 LIMITS EACH OCCURRENCE $ 1,000,00 A R PREMISES Ea occunence 300,00( $ � MED EXP (Any one person) $ 5,00 PERSONAL B ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 PRODUCTS - COMP/OP AGG $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO LOC $ A AUTOMOBILE LIABILITY ANY AUTO 5E11458 05/01/2015 05I01/2016 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ ALL OWNED AUTOS PROPERTY DAMAGE (PER ACCIDENT) $ SCHEDULED AUTOS HIRED AUTOS NON-OWNEDAUTOS X X X UMBRELLA LIAB EXCESS LUIB OCCUR CLAIMS -MADE 5J11458 05/01/2015 05/01/2015 EACH OCCURRENCE $ 1,000,00 AGGREGATE $ 1,000,00 - --- DEDUCTIBLE --- X I RETENTION $ 10000 WORKERS COMPENSATION STIMIT DER X TOCRY $ E.L.EACHACCIDENT $ 1,000,00 B A AND EMPLOYERS' LUIBILITY ANY YIN OFFICERIMEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Equipment Floater NIA 03353 5CI1458 10/01/2014 05/01/2015 10/0112015 05/01/2016 E.L. DISEASE - EA EMPLOYE $ 1,000,00 E.L. DISEASE - POLICY LIMIT $ 1,000,00 Lease0,00 anyonee 15150,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) License DM-374 IM CITYOFC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Fort Collins Building 8r Zoning Dept AUTHORIZED REPRESENTATIVE P.O. Box 580 Jim Olafson Fort Collins, CO 80522 All .. _r-4. ........-.—A J IJV V-LVVJ r,vv,�v vv�• v......�.-. .... ., ACORD 26 (2009/09) The ACORD name and logo are registered marks of ACORD