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Home My WebLink AboutST VRAIN ARBOR CARE - INSURANCE CERTIFICATEACORD. CERTIFICATE OF LIABILITY INSURANCE DATE D2004) 06/09/2004 PRODUCER (303) 776-5122 FAX (303) 776-5495 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION First Mai nStreet Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 512 4th Avenue HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P.O. Box 847 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Longmont, CO 80502 INSURERS AFFORDING COVERAGE INSURED INSURER ACNA St. Vrain Arbor Care 1117 Sherman Street Longmont, Colorado 80501 /Transportation ] INSURERB: CNA/American Casuals INSURER C: Pinnacol INSURER D: INSURER E: rance NAIC # THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTW ITHSTANDINI 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. NSR I133L AWL UM TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATIOCUMNJIM LIMITS GENERAL LIABILITY B1098548501 06/08/2004 06/09/2005 EACH OCCURRENCE $ 1,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PIRFMIS$ 1� ,0001 CLAIMS MADE rX OCCUR MED EXP (Any one person) $ 10.00( A PERSONAL & ADV INJURY $ 1,000,00( GENERAL AGGREGATE $ 2,000,00( GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000.00( POLICY JZ LOC AUTOMOBILE LIABILITY B1099548515 06/08/2004 06/09/2005 X COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) 1,000,000 '000DO ALL OWNED AUTOS BODILY INJURY $ B SCHEDULED AUTOS (Per person) X HIRED AUTOS X BODILY INJURY $ NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO 0 OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ S DEDUCTIBLE $ RETENTION $ $ WORMERS COMPENSATION AND 4025249 01/01/2004 01/01/2005 X WCSTATU- OTH- EMPLOYERS' LIABILITY I TOR LIMITS FR E.L. EACH ACCIDENT $ 100 C ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYE $ 100DD M yes describe under E.L. DISEASE - POLICY LIMIT $ 500 ,000 SPECIAL PROVISIONS below Contractor's Equip- B1098S48SO1 06/09/2004 06/08/2005 Per Schedule A Spec Form-$1,000 Ded DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS ertificate Holder is named as Additional Insured on General Liability only as respects Licensing and ermit. City of Fort Collins P.O. Box 580 Ft. Collins, CO 80522 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY IOND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Jennifer Milasinovich/JENNI AGUKU ZO (ZUUT/US) ©ACORD CORPORATION 1988