HomeMy WebLinkAbout196580 L & L LANDSCAPE - INSURANCE CERTIFICATE (12)Client#: 39557
LLLAN
A
ACORDTM CERTIFICATE OF LIABILITY INSURANCE
oiro7/0 DIYYYY)
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Flood & Peterson Ins. Inc.
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
P. O. Box 578
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
4687 W. 18th Street
Greeley, CO 80632
INSURERS AFFORDING COVERAGE
NAIC #
INSURED
L & L Landscape
Rob Dewald dba
P O Box 62
Windsor, CO 80550
INSURERA: United Fire & Casualty
INSURER B: Pinnacol Assurance
INSURER C:
INSURER D:
INSURER E:
COVERAGES
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
M EFFECTIVE
POLICY
DATE MWDDIYY)
LIMITS
A
GENERAL LIABILITY
60066660
04/20/03
04/20/04
EACH OCCURRENCE
$1 000 000
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE 51OCCUR
DAMAGE TO RENTEDPREMISES (Ea occurremIl
$100,000
MED EXP (Any one person)
$5 000
PERSONAL&ADV INJURY
$1 000 000
X PD Ded:250
GENERAL AGGREGATE
$2 OOO OOO
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS -COMP/OP AGG
$2 000 000
POLICY PRD LOC
A
AUTOMOBILE
LIABILITY
ANY AUTO
60066660
04/20/03
04/20/04
COMBINED SINGLE LIMIT
(Ea accident)
$500,000
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULEDAUTOS
X
X
BODILY INJURY
(Per accident)
$
HIRED AUTOS
NON -OWNED AUTOS
X
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
$
AUTO ONLY: AGG
EXCESS/UMBRELLA LIABILITY
EACH OCCURRENCE
$
AGGREGATE
$
OCCUR CLAIMS MADE
It
$
DEDUCTIBLE
$
RETENTION $
B
WORKERS COMPENSATION AND
4032158
08/01/03
08/01/04
WC STATU- OTH-
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
E.L. EACH ACCIDENT
$100,000
E.L. DISEASE - EA EMPLOYEE
$100,000
OFFICER/MEMBER EXCLUDED?
Des, describe under
SPECIAL PROVISIONS below
E.L. DISEASE - POLICY LIMIT
$5t00,000
OTHER
DESCRIPTION OF OPERATIONS! LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS
Certificate holder is named as Additional Insured.
City of Fort Collins
Purchasing Dept.
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 DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
ACORD 25 (2001/08) 1 of 2 #S252839/M252837
DJG G ACORD CORPORATION 1988
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.
AVWmu AQV tZUU I IUD) 2 ot2 #5252838/M252837