CT2015-013 COI

• Contract/PO #: CT2015-013
• Contract/PO #: C150317
• Contractor Name: Lake Durango Water Authority
• Contract Type: Grant/Loan Combo
• Loan Projects - Doc Type: Contract Documents

® DATE(MM/DD/YYYY)
ACCPR
CP CERTIFICATE OF LIABILITY INSURANCE 5/15/2018
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 have ADDITIONAL INSURED provisions or 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 CONTACT
NAME:
F&W Insurance PHONE [phone] AX,Not:303-444-8481
3005 Center Green Drive Suite 120 (A/c No_Fst
E-MAIL
Boulder CO 80301 ADDRESS:
INSURER(S)AFFORDING COVERAGE NAIC N
INSURER A:American Alternative Insurance Corp 19720
INSURED LAKEDUR-01 INSURERB:Pinnacol Assurance Company 41190
Lake Durango Water Authority INSURER C:
Charlie Smith
PO Box 657 INSURER D:
Durango CO 81302 INSURERE:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 1030822144 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' .ADDL SUBR POLICY EFF POLICY EXP LIMITS
LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY)
A X 1 COMMERCIAL GENERAL LIABILITY Y GPPAPF605052908000 4/29/2018 4/29/2019 EACH OCCURRENCE $1,000,000
' r DAMAGE TO RENTED
CLAIMS-MADE I X OCCUR PREMISES(Ea occurrence) $1,000,000
MED EXP(Any one person) $10,000
PERSONAL&ADV INJURY $1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000
X POLICY PRO-
JECT LOC PRODUCTS-COMP/OP AGG $3,000,000
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
(Ea accident)
ANY AUTO BODILY INJURY(Per person) $
OWNED SCHEDULED BODILY INJURY(Per accident) $
AUTOS ONLY AUTOS
- HIRED - NON-OWNED PSR PERTY DAMAGE $
AUTOS ONLY AUTOS ONLY (Per accident)
_ __ _
5
•
UMBRELLA LIAB OCCUR EACH OCCURRENCE S
EXCESS LIAB CLAIMS-MADE AGGREGATE i S
DED I . RETENTION$ S
B WORKERS COMPENSATION 4132493 1/1/2018 1/1/2019 X PER OTH-
AND EMPLOYERS'LIABILITY STATUTE ER -
ANY PROPRIETOR/PARTNER/EXECUTIVE Y�l N/A E.L.EACH ACCIDENT $500,000
'OFFICER/MEMBER EXCLUDED?
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $500,000
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000
DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
The Certificate holder is hereby named as an Additional Insured in respects to the General Liability portion of this certificate and limited to the
operations of the Named Insured.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Colorado Water Conservancy Board THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
1313 Sherman St.Suite 718 ACCORDANCE WITH THE POLICY PROVISIONS.
Denver CO 80203
AUTHORIZED REPRESENTATIVE `Al.
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