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Home My WebLink AboutTOP GUN - INSURANCE CERTIFICATE (5)ACORD GU-1 06/23/03 CERTIFICATE OF LIABILITY INSURANCE OPID LS DATE(MMIDDIYY) P PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Brown & Brown Inc - Ft Collins ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 125 S Howes, 5th Floor HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P O Box 2226 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Fort Collins CO 80522-2226 Phone:970-482-7747 Fax:970-484-4165 INSURERS AFFORDING COVERAGE INSURED INSURER A: MOUNTAIN STATES MUTUAL INSURER B: Pinnacol Assurance Top Gun Pressure Washing Inc. INSURERC: 50D W 67th St INSURER D: Loveland CO 80538 I _ __ INSURER E: nnVFRAmFC 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 TYPE OF INSURANCE POLICY NUMBER P LI Y EFFE IVE DATE MMIDDIV! POLICY EXPIRATION DATE MMIDDIYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR CPP007386401 10/21/02 10/21/03 EACH OCCURRENCE $ 1, 000, 000 FIRE DAMAGE (Anyone fire) I $ 100,000 MED EXP (Any one person) $ 10 , 000 PERSONAL & ADV INJURY $ 1 , 000 , 000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY SECO LOC T PRODUCTS - COMPIOP AGG $2,000,000 A1XX AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS , HIRED AUTOS NON -OWNED AUTOS BAP007386401 10/21/02 10/21/03 COMBINED SINGLE LIMIT (Ea accident) $ 1 OOO OOO � � BODILY INJURY (Per person) $ _Xj BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: AGG $ $ A EXCESS LIABILITY X OCCUR CLAIMSMADE DEDUCTIBLE X RETENTION $ 10000 UMB007386401 10/21/02 10/21/03 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY 4031609 07/01 /03 07, 01/0 x wc - - TORY LIMITS ER -.L. .cr;AcclDl;r $ 500 , 000 E.L. DISEASE - EA EMPLOYEE $ 500 , 000 E.L. DISEASE -POLICY LIMIT I $500, 000 A OTHER Leased/Rented Ecruiixmnt CPP007386401 10/21/02 10/21/03 Limit $100,000 Ded. $500 DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS I mm I Iri .Aim MULUCK I N I ADDITInNAI INS[IRFD• INRI IRFR I FTTFR• CANCFI 1 ATInN FTCCI TY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN City of Fort Collins NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Purchasing Department PO Box 580 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Fort Collins CO 80522 REPRESENTATIVES. cN AUTHORIZED REPRESENTATIVE ��'� I"., 1 V AL:UKU GUKI'UKA I IUN 1960 PRODUCER Pinnacol Assurance 7501 E Lowry Blvd DENVER CO 80230-7006 INSURED TOP GUN PRESSURE WASHING INC 3307 S COLLEGE AVE FORT COLLINS CO 80525 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMA"(4 O.MLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM AND 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO I TYPE OF INSURANCE I POLICY NUMBER I POLICY EFPECnN-E I POLICY EXPIRATION LIMITS NERAL LIABILITY COMMERCIAL GENERAL LIABILITY LAI CMSMADE ICI OCCUR OWNER'S & CONTRACTOR'S PROT ANY AUTO COMBDJED SIN( ALL OWNED AUTOS BODILY N`I'URV SCHEDULED AUTOS aaml HIRER AUTOS BODILY INJURY" NON -OWNED AUTOS (ov attHmU PROPERTY DAM RAGE LIABILITY AUTO ONLY - E ANY AUTO OTHER TNAN A' EACH AM UMBRELLA FORM WORKERS COMPENSATION AND I I I TORS WCSfATU U OTHER EMPLOYERS'LIABILITS A 4031609 01/01/2003 01/01/2004 EL EACHACCMMEM^T 500 000 THEPROPRIETORiPARTNERS/ INCL EL DISEASE-PoLICY LIMIT 500000 EXECUME OFFICERS ARH. EXCL EL DISEASE - EA EMPLOYEE 1 $500,000 OTHER DESCRIPPION OF OPERATIONsiLOCATIOM MEHICLES/SPECIAL ITEMS SEE BACK OF CERTIFICATE FOR CLASS COVERAGE AND OWNERSHIP COVERAGE DETAIL 702526 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE CITY OF FORT COLLINS EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL PURCHASING DEPARTMENT 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, PO BOX 580 BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR FORT COLLINS CO 80522 LIABILITY OF ANY KIND UPON THE COMPANY ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Elaine Rivera APOLIUND CSR Sg t 0710110 W54:58 40316 UpJa : 1211511M 12:WN M135 CERTIFICATE HOLDER COPY CITY OF FORT COLLINS PURCHASING DEPARTMENT PO BOX 580 FORT COLLINS CO 80522 POLICY NUMBER: 4031609 BUSINESS LOCATION: TOP GUN PRESSURE WASHING INC CLASSIFICATION OF OPERATION COVERAGE CLASS DESCRIPTION EFFECTIVE 521305 CONCRETE CONST N.O.C. 07/01/2003 822705 CONTR PERMANENT YARDS 07/01/2003 874205 OUTSIDE SALESPERSON 07/01/2003 881005 EXCLUSIVELY OFFICE 07/01/2003 COVERAGE RATING EXPIRES TYPE 07/01/2004 EM 07/01/2004 EM 07/01/2004 EM 07/01/2004 EM