HomeMy WebLinkAboutASPEN CONSTRUCTION - INSURANCE CERTIFICATE (4)ATE
ACORD CERTIFICATE OF LIABILITY INSURANCE D05/01/2017Y)
rM 05/01l2017
PRODUCER Phone: 970-775-3693 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Mountain Storm Insurance HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
5664 S I n Ct ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURED
ummer y
Windsor, CO 80650
Aspen Construction
DBA Gil Paben
204 N Link Ln
Fort Collins, CO 80524-2742
.AGES
INSURERS AFFORDING COVERAGE NAIC #
INSURER A: Security National Insurance Compa_y—�—
INSURER B: AIG
INSURERC: Pinnacol Assurance I
INSURER D:
INSURER E:
+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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
POLICY NUMBER VOL= EFFECTM 'DATE (MMIDD/Yn POLLCK fXPWAT"LIM Pd.. TYPE OF INSURANCE t DATE (MM/DDNYI LIMITS
A
GENERAL LIABILITY
X I COMMERCIAL GENERAL LIABILITY
1 CLAIMS MADE X OCCUR
' NA110846300 04/28/2017 04/28/2018
EACH OCCURRENCE
AGE TO RENTED
PREM SES Er a occurence)
MEN (Any one person) I
_
$ I Q-0-�000
$ 300 000
$ 6,000
$ 1 0-00.Q00
PERSONAL & ADV INJURY
GENERAL AGGREGATE_
$ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
�—
$ 2,000 90-
PRO- r__.
X POLICY 17 JECT 1 LOC
I
A
AUTOMOeILE
LIABILITY
ANY AUTO
SPP111567 04/28/2017 04/28/2018
I COMBINED SINGLE LIMIT
(Ea accident)
$ 1,000,000
A.j
X
X
ALL OWNED AUTOS
I
SCHEDULED AUTOS
HIRED AUTOS
NON•OWNEDAUTOS
I
BODILY INJURY
(Per person)
BODILY INJURY
(Per accident)
$
— -----
$
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABWTY
,I
_AUTO ONLY - EA ACCIDENT
$
$ _.,--._.__...___...___.....
$
OTHER THAN EA ACC
ANY AUTO _
AUTO ONLY: AGG
B
Eummum RELLAuABIuTY EBU063800113 1 04/29/2017 04/29/2018
X I OCCUR CLAIMS MADE I
EACH OCCURRENCE
AGGREGATE
$ 1,000,0_0_0
$ 1,000,000—
IJ T
DEDUCTIBLE
RETENTION $WC
$
C WORKERS COMPENSATION AND 3018240 06/01/2017 1 06/01/2018
I EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE I
OFFICERIMEMBEREXCLUDED? i
X , IRyTI("heTtTS 1 t ER
E.L. EACH ACCIDENT
1---"
E.L. DISEASE - EA EMPLOYEE
$ 500,000
i---
i____,_ SOO,000
I $ 500,000
' If yes, describe under
SPECIAL PROVISIONS below E,L. DISEASE - POLICY LIMIT
OTHER
i
!
'
I
1
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
ui1l t1 rA Mr f I AI Trim
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN
City of Ft Collins
Utl lltes
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO Do SO SHALL
PO BOX 580
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
Fort Collins, CO 80522
REPRESENTATIVES.
AUTHORIZED REPRES
KLH
ACORD 25 (2001/08) V A%IUKLJ klumrum/A I IUIY I V00
Printed by KLH on May 01, 2017 at 02:21 PM