HomeMy WebLinkAboutSTONY SOUTHCOTTE DBA ROCKY MOUNTAIN PLUMBING - INSURANCE CERTIFICATEACORD� CERTIFICATE OF LIABILITY
INSURANCE
DATE(MMIDD,YYYY)
07/17/2003
PRODUCER (970) 484-2805
John C. Beckett 6 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
Stony Southcotte DBA Rocky Mountain
Plumbing 6 Heating
4473 Hollyhock Street
Fort Collins CO 80526—
INSURERA:UNITED FIRE 6 CASUALTY
INSURERB:
INSURERC:
INSURER D:
INSURER E:
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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
LTR
ADD'L
INSRD
TYPE OF INSURANCE
POLICYNUMBER
POLICY EFFECTIVE
DATE MMIDD
POLICY EXPIRATION
DATE MMIDD
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE OCCUR
10401157331
07/18/2003
/ /
07/18/2004
EACH OCCURRENCE
$ 300,000
DAMAGE TO RENTED
PREMISES Ea occurrence
$ 100,000
MED EXP (Any one on
$ 5,000
PERSONAL 4 ADV INJURY
$ 300,000
GENERAL AGGREGATE
$ 1,000,000
NI AGGREGATE LIMIT APPLIES PER:
POLICY 7 JECT LOC
PRODUCTS - COMP/OP AGG
$ 1,000,000
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
NO COVERAGE
/ /
/ /
/ /
/ /
/ /
/ /
COMBINED SINGLE LIMIT
(Ea accident)
$
BODILY INJURY
(Per person)
$
BODILY INJURY
(Per accident)
$
PROPERTY DAMAGE
Per accident)
$
GARAGE LIABILITY
ANY AUTO
NO COVERAGE
I /
/ /
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
AUTO ONLY: AGO
$
$
EXCESSIUMBRELLA LIABILITY
OCCUR CLAIMS MADE
DEDUCTIBLE
RETENTION $
NO COVERAGE
/ /
/ /
/ /
/ /
EACH OCCURRENCE
$
AGGREGATE
$
8
$
$
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETORMARTNERIEXECUTIVE
OFFICER/MEMBER EXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
NO COVERAGE
/ /
/ /
/ /
/. /
C g IJ
TORY LIMITS OER
E.L. EACH ACCIDENT
8
E.L. DISEASE - EA EMPLOYEE
$
E.L. DISEASE - POLICY LIMIT
$
OTHER
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLEWEXCLUSIONS ADDED BY ENDORSEMENTISPECULL PROVISIONS
CITY OF FT. COLLINS
PO BOX 580
FORT COLLINS
25 (2001/08)
( ) — SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WALL 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 ANY KIND UPON THE
AUTHORIZED REPRESENTATIVE � � ,,(
CO 80522- �"' "'"' It
a ACORD CORPORATION 1988
tt,,�- INS025(olo8ps
ELECTRONIC LASER FORMS, INC. - (800)327-0545
Page 1 of 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)
J*,M INS025( iwyos Page 2of2