HomeMy WebLinkAbout106089 WESTERN STATES LAND SERVICES INC - INSURANCE CERTIFICATE (2)AC ORD CERTIFICATE OF LIABILITY INSURANCE CSR JS DATE (MMIDD/YYYY)
WESTS-1 ll 23 04
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Richards, Seeley, & Schaefer, ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
8670 Wolff Ct. #130 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Westminster CO 80031-3692
Phone:303-429-3561 Fax:303-427-0611
Western States Land Services
505 N Denver Avenue
Loveland CO 80537
COVERAGES
INSURERS AFFORDING COVERAGE NAIC #
INSURER A: American States Insurance
INSURER B: Pinnacol Assurance
INSURER C:
INSURER D:
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
INSR
TYPE OF INSURANCE
POLICY NUMBER
DATE MMIDD
MI DATE MDD EXPIRATION
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE [XI OCCUR
02-BO-887945-6
12/15/04
12/15/05
EACH OCCURRENCE
$ 1,000,000
PREMISES(Ea«curence)
$ 250,000
MED EXP (Any one person)
$ 10,000
PERSONAL$ ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY JECj
ECT LOC
PRODUCTS-COMP/OP AGG
$ 1,000,000
A
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
02-CD-150124-03
01/30/05
01/30/06
COMBINED SINGLE LIMIT
(Ea accident)
$1,000,000
X
BODILY INJURY
(Per person)
$
X
BODILY INJURY
(Per accident)
$
X
PROPERTY DAMAGE
(Per accident)
$
GARAGE LM"MLITY
ANY AUTO
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
AUTO ONLY: AGG
$
$
EXCESSIUMBRELLA LIABILITY
OCCUR CLAIMS MADE
DEDUCTIBLE
RETENTION $
EACH OCCURRENCE
$
AGGREGATE
$
$
B
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETORIPARTNERIEXECUTIVE
OFFICERIMEMBER EXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
1803222
01 /01ilOS
01101106
X TORY LIMITS ER
E.L. EACH ACCIDENT
$100,000
E.L. DISEASE - EA EMPLOYEE
$ 500,000
E.L. DISEASE - POLICY LIMIT
$ 10 0 , 000
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
•.vw�n l.NP1 �,CLLAIIVIV
CITY019 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIOi
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN
City of Ft. Collins NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
Nr O'Neil
PO BOX 580 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURE , ITS AGENTS OR
Ft. Collins CO 80522-0580 REPRESENTATIVES.
25 (2001108)