HomeMy WebLinkAboutBIO KLEAN WORLD ENVIRONMENTAL - INSURANCE CERTIFICATE (2)10/12/2007 11 04 9704842885
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AGORA CERTIFICATE OF LIABILITY INSURANCE
-
DAT9(MMIDD/Y1'YYI
10 10/2007
PRODUCER (970) 484-2805
John C. Beckett &Associates Ina
220 SmMth Street
Ft. 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
Bxo Klean world Environmental, Inc.
145 west Swallow Road; Ste A2
80rt Collxi CO 80525-2500
INSURERASURLINCTON 114SURAMCP CO
INSVRERB
INSURER
16URER D
IN URF,ftE
C[1VGCA GCC
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 WHIC14 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
)NSR
LTR
AD
N
TYPEOPINSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE MMID01'(Y
POLICY EXPIRATION
DATE MMIDDrcY
LIMITS
A
GENERAL
LIABILITY
21033522032
07/27/2007
07/27/2008
EACHOCCURREN E
E Boo, Too-
TTG RENTED
PRE IS6$ EsoeeurrA a
1 100,000
is 1
CAMMFR ALGENGRAL I.IAGILITY
CLAIMS MADE O OCCUR
/ /
/ /
MED EXp one raen
1 5,000
PERSON!µ A Am MUDRY
S 500,000
GENERALAGGRFG TE
E 1,000,000
AGOREOATE LIMIT APPLES PER
PRODu S-COMPIOPA G
S 1,000,000
GENL
X
POLICY JEL4T LOC
AUTOMOBILE
LIABILITY
ANY AUTO
NO COVERAGE
% /
/ /
COMBINED 60,14LE LIMIT
(Ed accident)
E
BODILY IN JURY
(PAr parson)
S
ALL OWNED AUTOS
SCHEDULED AUTOS
/ /
/ /
BODILY INJURY
(Per Occident)
S
HIRED AUTOS
NON OWNED AUTOS
/ /
/ /
PROPERTY DAMAGE
(Per Accident)
S
GAR AGE LIABILITY
AUTO ONLY -EA ACCIDENT
E
OTHERTHAN EA ACC
E
ANY AUTO
NO COVORAGS
/ /
/ /
E
AUTO ONLY AGG
EXCESSNMORMI-A LIABILITY
ND COVERAGD
/ /
/ /
EACH O CURRENCE
S
OCCUR CLAIMS MADE
AGGREGATE
1
S
DE000TIBLE
/ /
/ /
S
E
RETENRON S
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
NO COVERAGE
/ /
/ /
�WrCC
TOR `i ryT17-8 DERI
ANY PROPRIETORIPARTNEPoEXECUTNE
E4 EACH ACCIDENT
T
E L DISEASE FA EMPLOYEE
$
OrFICERM)FJMBER EXCLUDED?
/ /
/ /
If Yee dwrmunder
SPECIAL PROVISIONS cef.
F.L DISEASE -POLICY LIMIT
$
OTHER
NO COVERA=
/ / I
DESCRIPTION OF OPERATJONSADCATIDN$rMHICLES?SXCLU510NS ADDED BY ENDORSEMENWSPECIAL PROVISIONS
CITY OF FORT COLLINS
AnMINISTRATIW SEFtVSC"
P 0 BOX 580
#CORD 25
SHOULD ANY OF THE ABOVE DESORIRED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER W LL 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 ARY KIND UPON THE
IwTM- INS025 (0,08, 05 ELECTRONIC LASER FORMS, INC-(@OD)32T-D5AG PnBA 10 2
10/12/2007 11 04 9704842885
PACE 02/02
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(es) must be endorsed A statement on this
certificate does not confer rights to the cerbficate 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 Ileu of such
endorsement(s)
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing
msurer(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
2E 12001/081
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