HomeMy WebLinkAboutCORRESPONDENCE - GENERAL CORRESPONDENCE - INSURANCE CERTIFICATEACORD CERTIFICATE OF LIABILITY INSURANCE OP ID DATE (MM1DDlYYYY)
SILVCOO OS 13 03
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Jewell Insurance Associates HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
848 O h d R d St 3000 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
0 E. rc ar oa , e
Greenwood Village CO 80111
Phone:303-740-8101 Fax:303-740-8019
INSURED
Silvercool Service Co.
Maurine Ruble
3242 S. Platte River Drive
Englewood CO 80110
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INSURERS AFFORDING COVERAGE NAIC #
INSURER A: National Fire & Marine
INSURER B: Colorado Casualty Insurance
INSURERC: Pinnacol Assurance
INSURER D:
INSURER E
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.
SIR
DoLTR NSRD
TYPE OF INSURANCE
POLICY NUMBER
DATEYMMFDOCTIVE
POLICY
MM/DD/YYON LIMITS
A 11
!
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
7 CLAIMS MADE Fx ' OCCUR
PENDING i
05/01/03 !
EACH OCCURRENCE $ 1000000
05/01/04 PREMISES(Eaocarence)$ 100000
MED EXP(Any one person) j $ 5000
PERSONAL B ADV INJURY $ 1000000
ENERA GL AGGREGATE $ 2000000
PRODUCTS-COMP/OP AGG $ 2000000
1
lit
GENT AGGREGATE LIMIT APPLIES PER:
—�I POLICY PRO- JEC F, LOC
B
i
AUTOMOBILE
X
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIREDAUTOS
iNON-OWNED AUTOS
PENDING
05/01/03
1 05/01/04
COMBINED SINGLE LIMIT
(�acadant)
$ 1000000
J'
BODILY INJURY
(Par person)
$
X
BODILY INJURY
(Per accident)
$
X
PROPERTY DAMAGE ',, $
(Per accident)
GARAGE LIABILITY
ANY AUTO
AUTO ONLY - EA,
$
OTHER THAN EA ACC
AUTO ONLY: AGG
$
$
E7(CESSA/MBRELLA LIABILITY
OCCUR ' CLAIMS MADE
DEDUCTIBLE
RETENTION S
'I
�
EACH OCCURRENCE
$
AGGREGATE
! $
$
$
C
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
Des, describe under
SPECIAL PROVISIONS below
1771970
!
10/01/02
I
!
10/01/03
I
TORY LIMITS ER
E.L. EA CH ACCIDENT
! S 500000
E.L. DISEASE - EA EMPLOYEE!
$ 500000
E.L. DISEASE -POLICY LIMIT 1 $ 500000
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
r11=10711CIrArc un1 nco cAAIcc1 I ATInA1
FORT0 02
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City
Of Fort Collins
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN
Fax:
1- 3 0 3 - 2 21- 6 7 0 7
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
John
P. O.
Stephen
Box 580
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
Fort
Collins CO 80521
REPRESENTATIVES.
AUTHORIZED REPRGCFNTATIVE
AGORD 25 (2001l1010) 1 10 A bUKU L UKI-UKA I Ion Tau