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HomeMy WebLinkAboutSEALCO COATING WESTTERN 21ST CENTURY - INSURANCE CERTIFICATERciOR/9RR7 99.17 9706637183 PAGE 01 t A! ORD„ CERTIFICATE OF LIABILITY INSURANCEJIMATTOtToerz'" 6/07 — PRODUCER Walsh Insunuwe Agency, Inc. 1310 Ea3t Ebenllowel Blvd. Loveland, CO BOSS? (970)683-5404 Fax (970)663-7163 THIS CERTIFICATE IS ISSUED ASORMATION ONLY AND CONFERSNO RIGHTSICATEHOLDER THIS CERTIFICATE DOETEND OR R E AFFO S OW.Phone INSURERS AFFORDING COVERAGENAIL # INSURED Sealco Coating Westem Inc Dba- 21st Century Solutions 7894 Little FOX Ln, Wellington, CO, 60649-1651 INSURER A: Auto Owners - Lansing INSURER B: INSURERa INSURER D: INSURER E: COVERAGES INSURER F: THE POLICIES OF INSURANCE LISTED HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWI STANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUNENT Wr H RESPECT TO WHICH THIS CERTIFICATE MAY tSSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DEWED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CON IONS OF SUCH POLICIES, AGGREGATE UWTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAMS. AWL TYPE OF MgURANCE POLICY NUMBER �T3 M�EC� M C" PIRATION Yl LI S rA Q 6EiERAL LABILITY © COMMERCIAL GENERAL LIABILITY ❑❑ CL m MADE ® OCCUR ❑ 74002652 12/17/0e 12M 7/07 EACH OCCURRENCE 1,000,000 E11A3 3O a f*nu 50, 000 MED EXP Q" one pelao 5,000 PERSONAL d ADV INJUP f 1,000,000 ❑ GENERALAGGREGATE 2,000,000 GENL AGGREGATE UNT APPLIES PER: Q POLICY d PROJECT ❑ LOC PRODUCTS - COMP/OP 2, GOO, O00 _- A W9 AUT01403" UANLITY ❑ ANY AUTO ❑ ALL OWNED AUTOS © sCHEmAm AUTOS ❑ HIRED AUTOS ❑ NON OWNED AUTOS 4321444000 12/17/06 12/17/07 COMBINED SINGLE LMI a accident 1,000,000 BODILY INJURY r pereon _. BODILY INJURY (Par accident) PROPERTY DAMAGE (Per acods [] ❑ GAG.� yRY ❑ ANYAUTO ❑ EXCESS LIABILITY ElOCCUR ❑ wim MADE ❑ DEDUCTIBLE ❑ RETENTION AUTO ONLY - EA ACCIDI NIT OTHER THAN EA AUTO OHLY: A EACH OCCURRENCE AGGREGATE A WESPLOYES tCiOLMAPWILITY ON AND ANY PROPRIETOR A PARTNER / EXECUTIVE OFFICER / MEMBER EXCLUDED? E Yee, deecrte under SPECIAL PROVISIONS ttelow 74105635 12/17/06 12/17/07 ©WC TTU[]1 TH- E.L. EACH ACCIDENT 100,000 E.L. DISEASE • EA EMPL E 100.000 E.L. DISEASE - POLICY U IT 500,000 OTHER A INLAND MARINE 74002552 12/17/06 12/17/07 EQUIPMENT 6,000 DESCW PTION OF OPERATIONS I LOCATIONS A VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT) SPECIAL PROVISIONS V AUTO OWNERS FORM 55202- NO PRODUCTS OR COMPLETED OPERATIONS PROVIDED TO ANY AD ITIONAL INSURED. CERTIFICATE HOLDER IS ADDITIONAL INSURED. J CERTIFICATE HOLDER CANCELLATION I CITY OF FORT COLLINS 700 WOOD STREET FORT COLLINS, CO. 80521 ATTN: DWIGHT DUFLOTH 314OULD ANY OF THE ABOVE DESCRIBED POLICIES BE CAN D BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSUROt W3.L E EAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOL ER NAMED TO THE LEFT, BUT FAILURE TO DO 50 SHALL IMPOSE NO OBLIO TM OR UADILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR RET ATN". 06/25/2007 22.17 97066371B3 PAGE 02 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. A statement C n this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). It SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may i 3quIra an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu such endorsement(s). D13CLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between ths� Issuing inaurer(s), authorized representative or producer, and the certificate holder, nor does it affirma ely or negatively amend, extend or alter the coverage afforded by the policies listed thereon, ACORD 25 (200 M)