HomeMy WebLinkAboutSILVERCOOL SERVICE JBLANCO ENTERPRISE - INSURANCE CERTIFICATEACORD CERTIFICATE OF LIABILITY INSURANCE OP ID DATE(MMIDD/YYYY)
SILVCOO 01/20/05
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Jewell Insurance Associates
8480 E. Orchard Road, Ste 5500
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW
Greenwood Village CO 80111
Phone:303-740-8101 Pax:303-740-8019
INSURERS AFFORDING COVERAGE
NAIC#
INSURED
INSURERA: Lexington Iaeuranee Company
INSURER B: Pinnacol Assurance
Blanco l SNSURERC:
Blanco El nterprisService Co.0Inc. dba
8260 Brighton Roag
Commerce City CO 80222
Owners Insurance Company
32700
INSURER D:
INSURER E:
[Ke�V �:LCN Xc?
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.
LTR
NSR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE MFFECTI
POLICY MMIDD/EXPIRAION
DATE MMIDDITI
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$1,000,000
PREMISES Eaoccurence
$ 100,000
A
X COMMERCIAL GENERAL LIABILITY
41LX0332400
01/20/05
01/20/06
CLAIMS MADE 7X 1 OCCUR
MED EXP (Any one person)
$ EXCLUDED
PERSONAL B ADV INJURY
$1,000,000
GENERAL AGGREGATE
$ 2, 000, 000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS-COMP/OP AGO
$1,000,000
POLICY jEC LOC
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
$1,000,000
X
C
ANY AUTO
4487448700
01/20/04
01/20/05
(Ea accident)
ALL OWNED AUTOS
BODILY INJURY
$
SCHEDULED AUTOS
(Per person)
X
HIREDAUTOS
BODILY INJURY
$
X
NON -OWNED AUTOS
(Per accident)
PROPERTY DAMAGE
$
(Per accident)
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
ANY AUTO
OTHER THAN EA ACC
$
AUTO ONLY: AGG
$
EXCESSIUMBRELLA LIABILITY
EACH OCCURRENCE
$
OCCUR CLAIMS MADE
AGGREGATE
$
$
DEDUCTIBLE
$
RETENTION $
$
WORKERS COMPENSATION AND
-
TORY LIMITS ER
B
EMPLOYERS' LIABILITY
4076928
10/01/04
10/01/05
E.L.EACH ACCIDENT
$500000
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
E.L. DISEASE - EA EMPLOYE
$So 0000
If yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE -POLICY LIMIT
$ 500000
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
FORT002 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIOP
City of Fort Collins DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN
Fax: 1- 3 03 - 2 21- 67 0 7 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
John Stephen IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
P. O. Box 580
Fort Collins CO 80521 REPRESENTATIVES.
AUTHORIZED REP%rTA:E
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