HomeMy WebLinkAbout276712 FINE TREE SERVICE - INSURANCE CERTIFICATECOLORADO-BW INSURANCE Fax 19702672231
ACORD CERTIFICATE OF LIABILITY INSURANCE
PRODUDER (970)ZZ3-0924 FAX (970)267-Z231 THIS CERTIFICATE IS ISSUE
Colorado BW Insurance Agency, Inc. ONLY AND CONFERS NO Rig
1075 W Horsetooth Rd, Ste 306 HOLDER. THIS CERTIFICATE
ALTER THE COVERAGE AFF
Fort Collins, CO 80526
INSURED
3060 Delozier Drive Unit A
Fort Collins, CO 90524
rtTTVFoer�a
Aug 17 2007 09:I Gam P001/002
DATE (SMDDD/YYYY)
08/16/2007
LS A MATTER OF INFORMATION
INSURERS AFFORDING COVERAGE
INSUAERA: Hartford [The]
INSURERS: Pinnacol Assurance
INSURER C:
INSURER D:
INSURER E:
NAIC It
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, E(CLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
D' NAPETYPE
OF INSURANCE
POLICT NUMBER
POLK.W EFFECTNE
POLICY IXPI TION
LIMITS
GENERAL UABIUTI
34UUNSR4541
07/O5/2007
07/OS/2008
EACH OCCURRENCE
$ 1,000
X COMMERCALGENERALLA91UTY
DAMAGE TO RENTED
PRAMIqFA IF,
S 100,000
CLAIMS MADE OCCUR
MED EXP (Any one Rendn)
3 5,000
A
PERSONAL SADYINJURY
7 1,000,00
GENERALAGGREGATE
3 2,00000
GEN'L AGGREGATE LIMIT APPLIES PER.
PRODUCTS -COMNOP AGG
S 210001000
X POLICYF—j JECT PAID" LOC
AUTOMOBILE
X
LIABILITY
ANYAUTO
34UUNSR4541
07/05/2007
07/05/2008
COMBINED SINGLE LIMIT
(Ee Awdenl)
3
500,00
BODILYINJURY
(P.,Pvnon)
$
A
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON-OWNEDAUTOS
X
BODILY IN,NRY
(Pere Snt)
$
X
PROPERTY DAMAGE
(Per Rocident)
$
GARAGE LIABILITY
AUTO ONLY• EA ACCIDENT
S
OTHERTHAN EAACC
S
ANYAUTO
AUTO ONLY AGE
$
EXCESSNMBRELLA UAEIUTY
EACH OCCURRENCE
$
OCCUR ❑CLAIMS MADE
AGGREGATE
3
S
DEOUCTTSLE
$
3
RETENTION $
WORMERS COMPENSATION AND
4083365
07/01/2007
07/01/2008
X WC STATU- OTH-
B
EMPLOYERS' LIABILITY
ANY PROPRIETORPARTNERIEXECUTIVE
E.L. EACH ACCIDENT
3 10010
EL,OISEASE-FASMPLOYEE
3 100,00
OFFICERIMEM02R EXCLUDED?
SPECIAL ROVISONSbI.
EL DISEASE -POLICY LIMIT
$ 500.00
OTIIER
099CRIPMNQF P9RATION$/ LOCATIONS!VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT SPECIAL PROVISIONS
he City o? Fort Collins is listed as additional insured relating to the Insured's ongoing operations
City of Fort Collins
Purchasing Division
John Stephen
215 N Mason
PO Box 580
Fort Collins, CO 80522
ACORD 25 (2081IDB) FAX: (970)221-6707
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING W SURER WILL ENDEAVOR TO MAL
10 DAYS WRITTEN NOTICE TO THE CERTIPICATE HOLDER MANED TO THE LOT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NOOBLIGATION ON LIABILITY
(DACORD COf(PORATION 1988
COLORADO-Bill INSURANCE Fax 19702672231 Aug 17 2007 09:06am P002/002
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 ondorsement(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.
ACORD 25 (2001/03)