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Home My WebLink AboutCORRESPONDENCE - GENERAL CORRESPONDENCE - INSURANCE CERTIFICATE 2004DATE 08/2272W; ACORX2' , CERTIFICATE OF iLIABILITY INSURANCE' PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY Pinnacol Assurance AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS 7501 E Lowry Blvd CERTIFICATE DOES NOT AMEND. EXTEND OR ALTER THE COVERAGE DFNVER CO 80230-7006 AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE oMPAN) A PinnaCDl Assurance INSURED COMPANI- G & I WAGNER ENTERPRISES INC B COMPANN 14 LETITIA TRAIL RED FEATHER LAKES CO 80545-0397 C OnIPANY D COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM AND 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 SUBIECT TO ALL THE TERMS_ EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE OF INSURANCE POLICI NUMBER POLICY EFFHc IT, E POLICY EXPIRATION LIMITS LEE DATE.Al.... DAT&uw'W r 1 GENERAL LIABILITY GENERAL AGGREGATE PRODI:17TS COMPOP AGG CO.'.R.SERCIAL C:ENBR,\L LIABILITY CI AIh1.S MADE ❑ OCCUR PERSONAL A ADl' INJURY EACH OCCURRENCE O%NNER"S h CONTRACTOR'S PROT FIRE DAMAGE I me fdo MED ESP IAm' ouc w AUTOMOBILE LIABILITY AN}AUTO COMBINED SINGLE LIMIT BODILY INJURY ALL OWNED AUTOS SCHEDULED AUTOS 1 a crsuul BODILY INJURY HIRER AI ITOS NON-O\1NED AUTOS 11, ¢.k tl PROPERTY DAMAGE GARAGE LIABILITY AUTO ONLY - EA ACCIDENT OTHER THAN AUTO ONLY ........................................ ....................................... ....................................... ........................................ ANY AUTO EACH ACIDENT AGGREGATE EXCESS LIABILITY EACH OCCURRENCE AGGREGATE UMBRELLA FORM OTHER THAN UMBRELLA FORM WORKERS COMPENSATION AND WCSTATU- OTHER x Li EMPLOYERS' LIABILITY TORY LIhIITS - EL EACH ACCIDENT $100.000 A 4068533 05/01/2003 05/01/2004 ELDISEASE POLICYLIMIT S5OO.000 THE PROPRIETOR, PARTNERS INCL EL DISEASE - EA EMPLOYEE $ 100,000 ESECRR"E OFFICERS ART,: ETCL OTHER DESCRIPTION OF OPERATIONS LOCATIONS, VEHICLES,SPEI'LAL ITEMS RE: UTILITY DEPARTMENT SEE BACK OF CERTIFICATE FOR CLASS COVERAGE AND OWNERSHIP COVERAGE DETAIL CPsNTIlI'ICA'i'fitOLDER :- CANCELLATION .. 712S8(l SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE CITY OF FORT COLLINS EXPIRATION DATE THEREOF. THE ISSUING COMPANY WILL ENDEAVOR TO MAIL ATTN: UTILITY" DEPARTMENT _ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEiT. 700 WOOD SI'. BC"T FAILURE TO MAIL, SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR FORT COLLINS CO 80922 LIABILITY OF ANY KIND UPON THE COMPANY. ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Rodney Postillion Underwriter -lIKACOROCORP.QUATION 1988 ARCI SA.N% C.SR Stq,,,l I4{220, 12 14'4-1 I:1,DIul 12li IVA 11 I'll W U\VI?5 Commercial Certificate of Insurance AWFARM E R S� Agency , Jim Beemer Agency Name . 2705 W 10th Street Issue Date (MM/DD/YY) & • Greeley, CO 80634 08/22/2003 Address 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 St. 07 Dist. 04 Agent 356 coverage afforded by the policies shown below. Companies Providing Coverage: Insured Company A Truck Insurance Exchange . G&J Wagner Enterprises, Inc. Letter Name •Wagner Lawn Care Company B Farmers Insurance Exchange & • PO Box 397 ComLette CMfid-Century Insurance Company Address • Red Feather Lakes, CO 80545-0397 Letter Company Letter Coverages This is to certify that 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. Limits shown may have been reduced by paid clahns. Co. Lit. Type of Insurance yP Policy Number y Policy Effective Date (MM/DDm Policy Expiration Date (MWDDNY) Policy Limits c> y A X General Liability 045903234 5/5/03 5/5/04 General Aggregate $ 1,000,000 Commercial General Products-Comp/OPS Aggregate $ 1,000,000 Liability Personal & - Occurrence Version Advertising Injury $ 1,000,000 Contractual - Incidental Each Occurrence $ 1,000,000 Only Fire Damage (Arty one fire) $ 100,000 Owners & Contractors Prot. Medical Expense (Any one person) $ 5,000 A Automobile Liability Combined Single All Owned Commercial Dnnt $ 1,000,000 Autos Bodily Injury y Scheduled (Per person $ '\ 045903234 6/17/03 5/5/04 Hired Bodily Injury $ Non -Owned Autos (Per accident) Garage Liability Property Damage $ Garage Aggregate $ Umbrella Liability Limit $ Workers' Compensation Statutory and Each Accident $ Employers' Liability Disease - each Employee $ Disease -Policy Limit $ Description of OperationsNehicles/Restrictions/Special items: City of Fort Collins -Utility Department is an additional insured as their interests may appear. Certificate Holder Cancellation . City of Fort Collins Should any of the above described policies be cancelled before the expiration date Name . Utility Department thereof, the issuing company will endeavor to mail 30 days written notice to the & • 700 Wood Street certificate holder named to the left, but failure to mail such notice shall impose no Address • Fort Collins, CO 80522 obligation or liability of any kind upon the company, its agents or representatives. c An Representative 4-84 Copy Distribution: Nervice Center Copy and Agent's Copy H-Ui