HomeMy WebLinkAboutROGER ALBRECHT BIO KLEAN - INSURANCE CERTIFICATEACORD. CERTIFICATE OF LIABILITY INSURANCE
DATE
03/2 MIDO5/2005 3/205
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
Roger Albrecht DBA: Bio Klean
145 West Swallow Road, Ste A2
Fort Collins CO 80525-2500
INSURER A:EVANSTON INSURANCE CO.
INSURER B:
INSURER C:
INSURER D:
INSURER E:
1.rV YCRMVGJ
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
INSR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE (MMMDfM
POLICY EXPIRATION
DATE (MMIDDIM
LIMITS
A
GENERAL LIABILITY
/ /
/ /
EACH OCCURRENCE
$ 500,000
PRAEMGES EaExcurrence
$ 50,000
X COMMERCIAL GENERAL LIABILITY
MEDEXP (Any one on
$ 1,000
CLAIMS MADE a OCCUR
CLO50300449
07/25/2004
07/25/2005
PERSONAL B ADV INJURY
$ 500,000
GENERAL AGGREGATE
$ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS -COMPIOP AGG
$
X POLICY JECT LOC
AUTOMOBILE
LIABILITY
NO COVERAGE
/ /
/ /
COMBINED SINGLE LIMIT
(Ea accident)
$
ANY AUTO
BODILY INJURY
(Per Person)
$
ALLOWNEDAUTOS
/ /
/ /
SCHEDULED AUTOS
BODILY INJURY
(Per accident)
$
HIRED AUTOS
/ /
/ /
NON -OWNED AUTOS
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILRY
AUTO ONLY - EAACCIDENT
$
OTHER THAN FA ACC
$
ANY AUTO
0
NO COVERAGE
/ /
/ /
$
AUTO ONLY: AGG
EXCESSIUMBRELLA LABS.
NO COVERAGE
/ /
/ /
EACH OCCURRENCE
$
AGGREGATE
$
OCCUR CLAIMS MADE
$
$
DEDUCTIBLE
/ /
/
$
RETENTION $
_
NO COVERAGE
/ /
/
WORKERS COMPENSATION AND
T RY LIMI S ER
E.L. EACH ACCIDENT
$
EMPLOYERS' LIABILItt
ANY PROPRIETORIPARTNERIEXECUTIVE
OFFICERIMEMBER EXCLUDED?
/ /
/ /
E.L. DISEASE - EA EMPLOYEE
$
E.L. DISEASE -POLICY LIMIT
I $
If yes, describe under
SPECIAL PROVISIONS below
OTHER
NO COVERAGE
DESCRIPTION OF OPERATKINSILOCATIONSNEHICLE&EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
CITY OF FORT COLLINS
PURCHASING DIVISION
PO BOX 580
RD 25 (2001108)
INS025 (Oto3).po
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— C'
®ACORD
ELECTRONIC LASER FORMS, INC. - (800)327-0545
DN 1988
Pepe 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 (2001108)
0 Tr INS025 (010e).05 Paget oft