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HomeMy WebLinkAboutCHILLS WATER ICE - INSURANCE CERTIFICATEACORD. CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 05/11/2004 PRODUCER (970) 484-2805 John C. Beckett & Associates, Inc. 220 Smith 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 Chills Water P.O. BOX 692 Fort Collins Ice, LLC CO 80522- INSURERA:UNITED FIRE & CASUALTY INSURER B. INSURER INSURER D. INSURER E. COVERAGES 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. INSR I ADDI NSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POLICY EXPIRATION DATE (MWDONY) --- LIMITS A GENERAL LIABILITY / / / / EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS MADE aOCCUR PENDING 05/21/2004 05/21/2005 DAMAGE TO RENTED PREMISES Ea occurrence $ 100, 000 MED EXP (Any one person) S 5,006 PERSONAL &ADV INJURY S 1,000, 000 GENERAL AGGREGATE S 2,000,000 GEML AGGREGATE LIMIT APPLIES PER: X POLICY JECOT PRODUCTS - COMP/OP AGG $ 2,000,000 AUTOMOBILE LIABILITY NO COVERAGE / / / / COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS SCHEDULEDAUTOS / / / / BODILY INJURY (Per person) S HIRED AUTOS NON-OWNEDAUTOS / / / / BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) S GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO I NO COVERAGE / / / / OTHER THAN EA ACC S AUTO ONLY AGG $ EXCESS/UMBRELLA LIABILITY NO COVERAGE / / / / EACH OCCURRENCE S AGGREGATE $ OCCUR CLAIMS MADE $ DEDUCTIBLE RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY NO COVERAGE / / / / TORV LIMITS I R E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? If yes, describe under E.L. DISEASE - EA EMPLOYEE S E.L. DISEASE - POLICY LIMIT $ SPECIAL PROVISIONS below OTHER NO COVERAGE DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS l / — SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 010 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT CITY OF FT. COLLINS FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE PO BOX 580 1 INSURER, ITS AGENTS OR REPRESENTATIVES. FORT COLLINS CO 80522- 1125 (2001108) v© ACORD CORPORATION 1988 [f`7M IINI (0108)AS ELECTRONIC LASER FORMS, INC. - (81 Page 1 nr 2 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 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 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 (2001/08) ru INS025 (010e).05 Page 2 of 2