HomeMy WebLinkAboutGREENLINE SIGN SERVICES LLC - INSURANCE CERTIFICATE,4Co � CERTIFICATE 4F LIABILITY INSURANCE DATE(MM1D�lYYYY)
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THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVEtY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COV�I2AGE AFFORDED BY TI1E POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES N07 CONSTITUTE A CONTRACT BETINEEN THE ISSUING INSURER�S), AU7HORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certiiicate holder is an ADDITIONAL INSURED, the policy{ies) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAlVEO, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
this carti�cate does not confer rights to the certificate holder in lieu of such endorsement(s�.
PRoouCeR NnME: CoWesl Corporale
CoWest Insurance Services, LLC atc No ext : 1303) 688-9597 nrc No :;303) 688-8858
PO Box 910 ,;,,,AF«. info@cowest.com
INSURER(S) AFFORDIN(3 COVERAGE
Castle Rock CO 80104 INSURERA: dh�0 SBCUfily
INSURED INSURER 6� Oh�o CdSualty
Greenline Sign Services LLC iHSuftER C: Pinnacol Assurance
10500 Havana Ct Urrl F INSURER D�
NAIC N
24082
24074
41190
INSURER E :
BY�gh10n CO 80601 INSURERF:
COVERAGES CERTIF{CATE NUMBER: 24125 MASTER 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 VNTH RESPECT TO VNiICH THIS
CER'TIFICATE MAY BE ISSUED Oft MAY PERTAIN TFiE INSURAfJCE AFFORDED BY THE POL CIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY FiAVE BEEN REDUCED BY PAID CLAIMS
LTR TYPE OF INSURANCE INSD NN POLICY NUMBER MMID�lYYYY MMIpDlYYYY LtMITS
x COMMERCIALGENERALUABILITY EACHOCCURRENCE S �•000,000
CLAIMS-MAOF � qGCUR PREMISES Ea occurtence S 300.000
MED EXP (AM one person� S� 5,000
A BKS579D2220 03l2012023 03i20/2�24 pERSONALBADVINJURY S 1,000,0�0
GEN'LAGGREGATf- t IMIf APPLIES PER GENERALAGGREGATE S 2.ODO,O00
POLICY �X PR� � LOC PRODUCTS-COMPlOPAGG S 2•000,000
EC1
OTHER §
AUTOMOBILE LIABILITY COMBINEO SINGLE LIMIT S 1,000,000
Ea acadent
X ANY AUTO BOOILY INJURY (Per persati S
q OWNED SCHEOULED BAS57902220 0312012023 03l2D12024 BODILY INJURY (Par accidentl S
AUTOS ONLY AUTOS
HIRED NON-OWNEO PROPERTY DAMAGE S
AUTOS ONLY AUTOS OMLY Pe� ���
Unmsured motonst S 1.000.00�
UMeRELw LIAB """'""""" ""'y" """" 1,000,000
X X OCCUR EACH OCCURRENCE S
B EUCESS LIAB aaIMS-MADE US057902220 Q3120/2023 Q3/2012024 AGGREGATE 5 1,000,000
DED X RETENTION b�0,000 S
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY !� STATUFE ER
Y 1 N 500,000
C AfJYPROPRIETORlPARTNER/EXECUTIVE � N7A 4207455 02l0112024 0210112D25 E.L EACHACCIDEMT S
OFFICERlMEMBER EXCLUDEO�
(Mandatory in NH) E L DISEASE - EA EMPLOYEE S 500,000
�� ves. Oestnbe under 500,000
OESCRIPTION OF OPERATiONS bBlOw E L DISEASF POIICY LIMIT 5
DESCRIPTION OF OPERATONS! LOCATIONS 1 VEHICI.ES (ACORD 101, AddNlonal Remerks Schedule, may be atteched if mort epace Is requlred►
CERTIFICATE IiOLDER
CITY OF FORT COLLINS
281 N COLLEGE
CANCELLA
SHOULD ANY OF THE ABOVE DESCRIB6D POLICIES BE CANCELLED BEFORE
THE EXPIRATION UATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
FORT COLLINS
CO 80524
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