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HomeMy WebLinkAboutCARNES SERVICES - INSURANCE CERTIFICATE (3)ACORD,„ CERTIFICATE OF LIABILITY INSURANCE DATE/D) 05/0404/20072007 PRODUCER (970) 484-2805 John C. Beckett &Associates, Inc. 220 Smith Street F -. Collins CO 80524- THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED Carnes Services, LLC PO Box 1258 Wellin ton CO 80549- INSURERA:Burlington Insurance Cc INSURER B: Northl and Insurance INSURER C:PINNACOL ASSURANCE CO. INSURER D: INSURER COVERAGES 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. INSR LTR ADVL INSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM/DD/YY POLICY EXPIRATION DATE (MM/DD/VY) LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE FxI OCCUR 210BR00067 / / / / 02/27/2007 / / / / 02/27/2008 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 MED EXP (Any oneperson) $ 5,000 PERSONAL &ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 nGEN'L AGGREGATE LIMIT APPLIES PER: X POLICY JE LOC PRODUCTS - COMP/OP AGG $ B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIREDAUTOS NON-OWNEDAUTOS CT129847 / / 09/18/2006 / / / / 09/18/2007 / / COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ X BODILY INJURY (Per accident) $ PROPERTYDAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO NO COVERAGE / / / / AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: AGG $ $ EXCESSIUMBRELLA LIABILITY OCCUR F1 CLAIMS MADE DEDUCTIBLE RETENTION $ NO COVERAGE / / / / / / / / EACH OCCURRENCE $ AGGREGATE $ $ $ $ O WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below 4056971 05/01/2007 05/01/2006 1 X WCSTATII- OTH- TORY LIMITS ER E.L. EACH ACCIDENT 5 1,000,000 E.L. DISEASE - EA EMPLOYEE$ 1,000,000 E.L. DISEASE - POLICY LIMIT I $ 1,000,000 OTHER NO COVERAGE DESCRIPTION OF OPERATIONS/LOCATIONSfVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS FICATE HOLDER CITY OF FT. COLLINS/STREETS DEPT PO BOX 580 FT. COLLINS ACORD 25 (2001108) *T, INS025 (otoa).o5 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE AUTHORIZED REPRESENTATIVE ELECTRONIC LASER FORMS, INC.-(B00)327-0545 © ACORD CORPORATION 1988 Page 1 of 2 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. AUUKU 25 (2007/08) 0 INS0251010el.05 Page 2 of 2