HomeMy WebLinkAboutROGER ALBRECHT BIO KLEAN - INSURANCE CERTIFICATE (2)F.5
ACORD. CERTIFICATE OF LIABILITY INSURANCE
0DATE 6/03/D 04
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PRODUCER (970) 484-2805
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Sohn C. Beckett S Associates, Inc.
ONLY AND CONFERS NO RIGHTS
HOLDER THIS CERTIFICATE DOES
UPON THE CERTIFICATE
NOT AMEND, EXTEND OR
220 Smith Street
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW,
Et. Collins CO 80524-
INSURERS AFFORDING COVERAGE
NAIC #
INSURED
NSURERAEVANSTON INSURANCE
Roger Albrecht DBA Bio Klean
INSURER B.
_
145 West Swallow Road, Ste A2
INSURER C:
INSURER O:
Fort Collins CO 80525-2500
INSURERS
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHST:'.NOING ANY j
REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR M ",Y PERTAIN,
IiJ
THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUC P-C.ICIES.
AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
D'L
N
....
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE(MMIDDIYY
POLICY EXPIRATION
DATE(MWOD(YY)
......
LIMITS
A
GENERAL LIABILITY
f /
% J
EACH OCCURRENCE
1 500,000
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE I—x I OCCUR
CLOS0300270
07/25/2003
07/25/2004
DAMAGE TO RENTED
PREMISES Es ocevnance
S 57 000
MEDEXP (Any one m)
1
PERSONAL 6 ADV INJURY
_J1,000
S 50Q,000
GENERAL AGGREGATE
S '-,000,000
GEN'L AGGREGATEppLRRINpTAPPLIES PER:
PRODUCTS -COMPIOP AGG
$
�
X POLICY JECT LOC
I /
f f
AUTOMOBILE
LIAINUTY
ANYAUTO
NO COVERAGE
J f
/ J
COMBINED SINGLE LIMIT
(Ea aoddent)
S
-
BODILY INJURY
(PerPB1JOn)
S
ALL OWNED AUTOS
SCHEDULED AUTOS
J I
/ J
BODILY INJURY
(Per accident)
HIRED AUTOS
NON -OWNED AUTOS
J /
/ J
PROPERTY DAMAGE
(Per a¢Benl)
S
GARAGE LIABLLRY
AUTOONLY-EAACCIDENT
ANYAUTO
NO COVERAGE
f /
J f
OTHER THAN EA ACC
S
S
AUTO ONLY: AGG
ESCESSIUMBRELLA LIABILITY
NO COVERAGE
/ f
/ %
EACH OCCURRENCE
1
AGGREGATE
II i
OCCUR ❑CLAIMS MADE
1 i
DEDUCTIBLE
WC M RR �IEEMPLOYERS'
I5
S i
RETENTION 5
WORKERCOMPENSATION AND
LIABILITY
NO COVERAGE
ANY PROPRIETORIPARTNERlEXECUTIVE
If yn. deambe uno EXCLUDED?
It yeas, desed6e under
E.L. EACH ACCIDENT Is
E.L. DISEASE - EA EMPLOY
S
E.L. DISEASE - POLICY LIMIT I
S
SPECIAL PROVISIONS below
OTHER
NO COVERAGE
DESCRIPTION OF OPERATIONSILO:ATIONSNEHICLE&tFXCLUSWNS ADDED BY ENOORSEMENTISPECIAL PROVISIONS
t
( } — (970) 224-6134 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED EFORF. 7HE 7
EXPIRATION DATE THEREOF, THE ISSWNO INSURER WILL ENDEAVC.R TO MAIL
10 DAYS WIOTCEN NOTICE TO THE CERnFICATE HOLDER NAMED TO T ,E LE -, BUT
CITY OF FT COLLINS FAILURE TO DO 50 SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KI tD UPON THE
281 N . COLLEGE INSIORER ITS AGENTS OR REPRESENTAnvEs. _
P.O. BOX 580 AUTHORIZED REPRESENTATIVE
FORT COLLINS CO 80524- �^ t
ACORD 25 (2001103) 0 ACORD CORPORATION 1988
*, INS025(oioa Ds ELECTRONIC LASER FORMS, INC. -(WO)327-05a5 age Iof
p.6
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 forth 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.
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