HomeMy WebLinkAboutROCKY MOUNTAIN BATTERY SERVICE OF FORT COLLINS INC - INSURANCE CERTIFICATE 2019-2021CERTIFICATE OF LIABILITY INSURANCE °p'�,MM��"""'
10/09/2020
TNIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOL�ER. TMIS
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 6ETWEEN THE ISSUING INSURER(S), AUTHORI2ED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAI INSURED, the policy(ies) must 6e entlowaa. rc sueKu�Aiiun i� wrwveu, suo�nc�.o
the terms and condWons of the policy, certain policies may require an andorsement. A sfatement on this cert'fiicate does not confer rights to the
rnooucea
Stansfleld Insurance Agency
5126 S Gollege Ave, Suite B
Port Collins, CO 80525
ph-970-204-0020 fx-970-204-0305
INSURED
Rocky Mountsin Battery Service of Fort Collins, Inc.
1475 N College Avenue
FoR Collins Co 80624
THIS IS TO CERTIFV THAT THE POLICIES OF INSURANCE LISTE� BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTMTHSTANDING ANV RE�UIREMENT, TERM OR CONDITION OF ANV CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAV BE ISSUE� OR MAY PERTAIN, THE INSURANCE AFFORDED 8Y THE POLICIES DESCRIBED HEREIN IS SUBJECT TO AlL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAV HAVE BEEN REDUCED BV PAID CLAIMS.
�.w ._________ ____ AO�LSOBR _______..____ POLICVEFF POLICYE%P
.....______.. ,....� ............. LIMI15
B GENERALLIPBILITY
X COMMERCIALGENERALLIABIIJTV
CL4IMSMA�E X❑ OCCUR
X Prod-Comp Ops
X Broad Form PD
GEN'L AGGREGATE LIMIT APPLIES PER:
X POLICY PRa LOC
A Al1TOMOBILELIABIIJTY
X ANYAlJrO
X ALLOWNEDAUTQS
SCHEOIILEDAUTOS
HIREDAUT0.S
NON-0WNEDAUT0.5
❑MBRELIALIAB p�CUR
EXCESS LI/ B CLAIMSlMDE
DEDUCTIBLE
RETEMION 5
WORKERSCOMPENSPTION
NNOEMPLOVERS'LIABILITY YIN
ANY PROPRIETOR/PARTNERIEXEGUTIVE ❑
OFFIGER/MEMBER EXCLUOEDi
X I X I MP0043002003062 I10/08/209
X IX
s1,000,000
BOOILVINJURY(Perperson) $
BODILY INJURV (Peraaitlanl) $
PROPERTY �AMAGE
OESCRIPTION OF OPEMTIONS I LOCAl10N51 VEHICLES (AMeeM1 AGORU 101, Pdtlitionel Rematks ScM1edule, if mare epece is reqWreE)
Battery Dealer/Recyeling Services
CERTIFICATE HOLDER CANCELLATION
City of Fort Collins
SHOULO ANY OF TNE ABOVE OESCRIBED PoLICIES HE CANCELLED BEFORE
PO BOX 580 7F{E E%PIRA710N UATE THEREOF, NOTICE WILL BE DELIVERED IN
FOR COIIIf18 CO 80522 ACCORDANCE WITH TME POLJCY PROVISIONS.
phone#970-221-6775
faxll870-221$707 Ar�TM�OR�IZ�ED REPRESENTAPVE
Attn: Ed 8onnette �L rJ! ��
J'rt�
OO 1988-2009 ACORD CORPORATION. All rights reserved.
ACORD 25 (2009/09) The ACORD name and logo are registeretl marks of ACORD
POLICY NUMBER: MP0043002003062
COMMERCIAL GENERAL LIABILITY
CG 20 10 0413
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - SCHEDULED PERSON OR
ORGANIZATION
This endorsemeM modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s) Location(s) Of Covered Operations
Or Or anization s :
CITY OF FORT COLLINS
PO BO% 580
FOR2'�COLLINS, COLORADO 80522
Information re uired to com Iete this Schedule, if not shown above, will be shown in the Declarations.
A. Section 11 — Who 1s An Insured is amended ro
include as an additional insured the person(s) or
organization(s) shown in the Schedule, but only
witfi respect tq lia6ility for "bodily injury", "property
damage"� or "personal and advertising injury"
caused, in whole or in part, by-
�1.. Vouracts�oromissions;or
2. The acts or omissions of those acting on your
bahalf;
in the performance of your ongoing operations for
the �additionai insured(s) at the location(s)
dasignated above.
However:
1. The insurance afforded to such additional
insured only applies to the extent permitted by
law; and
2_ IPcoverage provided to the additional insured is
required by a contract or agreement, the
insursnce afforded to. such additional insured
will not be broader than that which you are
repuired by the contract or agreement to
provitle for such adtlitional insured.
B. With respectto the insurance afforded.to these
additional insureds, the following additional
exclusions apply:
This insurance dces not apply to "6odily injury" or
"property damage" occurring aker..
1. All work, including materials, parts or
equipment Turnished in connection with such
work, on the project (other than service,
maintenance or repairs) to be performed by or
on behalf of the additional insured{s) at the
Iocation of the covered operations has been
completed; or
2. That portion of "your work" out of which the
injury or damage arises has been put to its
intendad use by any person or organizadon
other than another contractor or subcontraotor
engaged in perForming operations for a
principal as a part of the same project.
CG 2010 Q4 13 � Insurance Services Office, Inc., 2012 Pdge 1 Of 2
Znaured Copy
C. With respec[ to the insurance afforded to these 2. Availabie under the appiicsble Limits of
eddilional Fnsureds, the following is added to insurance shown in the DeGarations:
Seetion III — Limits Of Insurance: whichever is less.
If coverage provided to the additional insured is This endorsement shail not increase the applicable
cequ4red by a contract or agreement, the most We Limitsof insurance shown in the�DeciaraUons.
will pay on behaif of�the addifional insured is the
amount of insurance:
L. Required by the contract or agreament; or
CG 2010 0413 � Insurance Services Office, Inc., 2012 Page.2 Of.2.
POUCY NUMBER:n�o043002003062 COMMERCIAL GENERAL LIABILITY
CG 24 04 05 09
WAI�/ER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US
This endorsement modifies insurance provided under the following:
COMMERCfAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
SCHEDULE
Name Of Pereon Or Organization:
CITY OF FORT COLLINS
PO HOE 580
FQRT COLLINS, COLORADO 80522
Information required to complete this Schetlule, if not shown a6ove, will be shown in the Deciaratlons.
The following is added to Paragraph 8. Transfer Of
Rights Of Recovery Agalnst Ofhers To Us of Sec-
tiun N—Conditions:
We waive any right of recovery we may have against
the person or organization shown in the Schedule
above�� because of payments we make for injury or
danlage arising out of your ongoing operations or
"your work" done under a contract wiih that person
or organization and inciuded in the "products-com-
pletetl operations hazard". This waiver applies only
to the person or organization shown in the Schedule
above.
CG 24 04 05 09 o Insurance Services office, Ina, 2008 Page 1 of 1
Insured Copy
�CORP� CERTIFICATE OF LIABILITY INSURANCE �ATE(MMI�OITTYY�
`,� osio2izo2�
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLV AND CONFERS NO RIGHTS UPON THE CERTIF�CATE 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.
IMPOR7ANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain polieies may require an endorsement. A statement on this certificate does not confer rights to the
PROOUCER
Stans£eld Insuranee Agency
5125 S College Ave, Suite B
Fort Collins, CO 80525
pN-970-204-0020 fx-970-204A305
INSURED
Rocky Mountain Battery Service of Fort Collins, Inc.
1475 N College Avenue
Fort Collins Co 80524
MP0043002003062
REVISION
21652 __
36838
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICV PEF21cJU
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAV BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TD ALL THE TERMS,
EXCLUSIONS AND CON�ITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
NSR IIOOLSIIBR POLILYEiF POLIGYEXP
LTR TYPEOFINSORANCE INSR WVD POLILVNOMBER �MMIDU/YYVY) (MM/DDM'YY� 4MR5
B GENERALLIABILITV X x MP0043002002666 70/OS//19 �Q��S�2� ��CHOCCURRENCE IS�,���,��0
� CLAIMS-MAOE LA � OCCUR
Prod-Comp Ops
Broad Form PD
'L AGGREGATE LIMIT APPLIES PER:
R POLIGV
A AUTOMOBILE LIABILITY
X ANV AUTO
��:�Ia\��iTT��7ilqPb9
SGHEW LEO AlIT05
HIRED AIITOS
NON-OWNED AUTOS
UMBRELLALIAB OCCUR
E%CE53 LIAB ri eu�c.
DEDUCTIBLE
X I X 1603271522
: MESA Underwriters Specialty
: Scottsdale Insurance Co
0/08/21
COMP/OP
COMBMED SINGLE LIMIT
(Ea acGtlent)
BODILY INJURY (Per pers�
BO�ILY INJl1RV (Per accic
PROPERTV DAMFGE
(Per2ccitlenl)
s2,000 000
a2.000 000
$ 100.000
$ � �0�0�00�
$ _
$ — _
$ _
y_ . . . _ ----
5
WORKERS LOMPENSATION
ANOEMPLOYERS'LIA6ILITY ,.�H
ANV PROPRIETOR/PAftTNER/EXECUTIVE ❑
OFFICER/MEMBER E%CLUDED. N f A
IMandatory In NHl
EL EACH ACCIDENT
E.L. �ISEASE - EA EM
OESCRIPTION OF OPERATION51 LOCATIONS / VEHICLES (Apach ACORO 101. Atltlilional Remarks Schedule, it more space Is requiretl)
Battery Dealer/Recycling Serviees
City of Fort Collins
PO Box 580
Fort Collins CO 80522
phone#970-221-6775
fax#970-221-6707
Attn: Ed Bonnette
SHOULD ANV OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION �ATE THEREOF, NOTICE WILL BE DEIIVERED IN
ACCORUANCE WITH THE POLICV PROVISIONS.
AUTHORIZED REPRESENTATIVE
� �'�
O 1988-2009 ACORD CORPORATION. All rights reserved.
ACORD 25 (2009/09) The ACORD name and logo are registered marks of AGORD
CERTIFICATE OF LIABILITY INSURANCE onre�rnMmorcrrv�
os,onzoz,
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFER5 NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR AITER TNE COVERAGE AFFORDED 6Y THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN TNE 133UING INSURER�S�, AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the cert�wte holder is an A[
the terms and conditions of the policy, certain
eertiflcate holder in lieu of such entlorsementG
rRooucea
Stansfleld Insurence Agency
6126 S College Ave, Suite B
Fort Collins, CO 80525
ph-970-204-0020fx-970-204-0306
1L INSURED, the policy(ies) must be entlorsed. If SUBROGATION IS WAIVED, su6ject to
may require an entlorsement A sfatament on this certificate does not conter rights to the
WSURED
Rocky Mountain Battery Service of Fort Collins, Inc.
1475 N College Avenue
Fort Collins Co 80524
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSIIED TO THE INSURED NAME� ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANV CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAV BE ISSUEO OR MAV PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAV HAVE BEEN REDUCED BV PAID CLAIMS.
��Tp NPEOFINSURINLE ODLSUBR pOLICYNUMBER MMIODYttYVY MMOCD � LIMITS
B GENERALLJABILITV X X MP0043002002666 10I08/N9 10/08/20 EncHoccuaaeNce s1000000
X COMMERCIALGENERAILJABILITY MPD043002003062 iO/OH/ZO iO/OH/2i PREMSET�EaEo¢urrence 5 iOOOOO
CIAIM&MADE �OCCUR ME�EXP(Anyoneperson) 8 $Q0�
X Prod-Comp Ops PERSONNlBAOV INJl1RV Si ��� Q��
X Broad Form PD GENERALAGGREGATE 52 OOO OOO
GEMLAGGREGATELIMITAPPLIESPER: PROOUCTS-COMP/OPAGG $ZOODOOO
X POLICV PRo- �oc Fire Le al 5 100 000
(� Al1TOMOBILELIABILITY X X 603271622 5/09/20 05/09@1 COM6MEOSINGLELIMIT b,�'000r000
(Ea acdtlent)
X ANYAUTO 05/09/21 �rJ��9�Z2 gODILVINJURY�Pe�person) S
X ALLOVJNEOAOTOS BOOILVINJURY(Pe�eccidenl) 5
SCHED�LEDAUTOS PROPERTY�AMAGE 5
HIREDAUTQS (PeraaiJenq
S
NON-0NMED AUTQS
E
UMBRELLALIAB pCCUR FACHOCCURRENCE S
EXCESS LIAB CLAIMS-MADE AGGREGATE 5
DE�UCTIBLE g
RETENTION 5 S
WORKERSCOMPENSATION WCSTATU- OTH-
AN�EMPLOVERS'LJABILITY Y/N
ANY PROPRIETORIPARTNER/EXECUTIVE ❑ N�p E.L. EACH ACCIOENT $
OFFICER/MEMBER E%GLUDEO?
�MenOabrylnNH) E.LDISEASE-EAEMPLOVE S
H yes, Eeusibe untler
DESCRIPTIONOFOPERATIONS�etow E.LD�SEASE-POLICVLIMIT S
OESCRIPTIONOFOPERATONS/LOCA110N5/VEHICLES (AttachPCORD101,Atldi4onalRema�ksScM1edule,'rfmarespaceisrequiretl)
Battery Dealer/Recyeling Services
City of Fort Collins
PO Box 560
Fort Collins CO 80522
phone#970-22�-6775
fax#970-221-6707
Attn: Ed Bonnette
SNOULD ANV OF THE ABOVE DESCRIBED POLICIES BE CANCELIED BEFORE
THE EXPIRATION DATE THEREOF, NOTCE WILL BE DELIVERE� IN
ACCORDANCE WI7H TXE POLICY PROVISIONS.
n..u��TM--��owzeo
��
� � 1988-2009 ACORD CORPORATION. All
ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD
�`�p �� CERTIFICATE OF LIABILITY INSURANCE °"'�`M"'°°"""''
L...-�-� osio�noz,
THIS CERTIFICATE IS ISSUEU AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER TNIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATNELY 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 certiflcate holder is an ADDITIONAL INSURED, the policy(ies) must ba endorsed. If SUBROGATION IS WAIVED, subJect to
the terms and conditions of the policy, car[ain policies may require an endorsement. A statement on this certificate does not confer rights to the
tartifiwte holder in lieu of such endorsemenys�.
arsooucea cor�rncr
NqME:
StansfeldlnsurenceAgeney a�"x �,g70-204-0020 acr�o:970-204-0305
5125 S College Ave, Suite B E-MAIL
aoorsess:
Fort Collins, CO 80525 PRODUCER
cu r Meaiox:
ph-970-204-0020fX-970-204•0305 INSURE 5 AFFORDINOCOVERACaE NAICf
iNsuaeo ixsuaersa: Farmers Insurance 27652
Rocky Mountain Battery Service of Fort Collins, Inc. �r,suaeae: MESA Underwriters S eeiaf 36838
'1475 N College Avenue iHsuaeac: Scottsdale Insurence Co
Fort Collins Co 80524 INSURERD:
iusuaEa e :
INSURERF:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE 9EEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICV PERIOD
INDICATED. NOTMTHSTANOING ANV REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAV PERTAIN, THE INSURANCE AFFORDEO 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.
INeR rypEOFINSIIRANCE AOOLSl19R POLICYEFF POLICVE%P IJMITS
LTR POLICYNUM6Eft MMIOOIVYYY MMIOOM'YV
B GENERALLIABILITY X X MP0043002002666 i0��8���9 10�08�2� EAGHOGGURRENGE 51��00��
X GOMMERGIALGENERAWABILITY MP0043002003D62 'IO/OBIYO iO�OSIY'I PREMSES ESEoaaurence $ �OOOOO
CL41MS-MAOE �OCCUR ME�EXP(Myopeperson) $ SOOO
X Prod-CompOps PERSONALSADVINJURV Si��00��
X Broad Form PD GENERAIAGGREGATE SZ OOO OOO
GEN'IAGGREGATELIMITAPPLIESPER: PRODUCTS-COMP/OPAGG SYOOOOOO
X Poucv PR�- LOC Fire Le al S 100 000
A AIITOMOBILELIABILITY �( X fi03271522 Q§/Q9/ZQ ��j/�9/Q� COMBINEOSINGLELIMIT $�'00o'QOO
X ANYAi1T0 OSI09/21 p$fOQ/'j2 (Eaaccitlen�)
BODILYINJURY(Pe�pe�mn) §
X ALLOWNE�AUTOS BO�ILYINJURY(Perarcitlent) §
SCHEDl1LED AIITOS
--- PROPERTYDAMAGE S
MIREDAOTQS (PefeCptl¢0�)
NON-0WNEDAIfTOS 5
5
UMBRELLAUAB p�CUR �CHOCCIIRRENCE 5
EXCESS LIAB CLAIMSMADE AGGREGATE S
DE�UCTIBLE s
RETENTION E 5
WORKERSCOMPENSATION WCSTATU- OTH-
AND EMPLOYERS' IIqBILITY Y/ N �
FFICERIMEMBER F�(CUNIDED ECOTIVE ❑ N �p E.L. EACH ACqDENT 5
(MandatorylnNH� E.L.DISEASE-EAEMPLOVE 5
if yee, Oasuibe untler
DESGRIPTIONOFOPERATIONSbelow E.LDISEASE-POLICYLIMIT 5
DESCRIPTIONOFOPERATONS/LOCATONS/VEHICLES (Attac�ACORD101�AJtlitionalRema�kzScl�edule,ifmorespeceisrequiretl)
Battery Dealer/Recycling Services
City of Fort Collins
PO Box 580
Fort Collins CO 80522
phone#870-221-6775
fax#970-221-6707
Attn: Ed Bonnette
ACORD 25 (2009/09)
SHOIILD ANY OF 7HE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, N0710E WILL BE DELIVERED IN
ACCORDANCE WITH THE POLJCV PROVISIONS.
��
�O 1988-2009 ACI
The ACORD name and logo are registered marks of ACORD