HomeMy WebLinkAbout102136 KORBY - INSURANCE CERTIFICATEAUG-22-2005 12:24 PanTEST
303 650 0898 P.01
ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID
DATE(MMIDDIYYYY)
RORBY-1
08 22 05
PRODUCER
THIS CERTIFICATE 18 ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Insurance Advisors P & C Agenc
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
8774 Yates Dr. Ste. 100
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Westminster CO 90031
Phones 303-996-5273
INSURERS AFFORDING COVERAGE
NAIC#
INSURED
INSURERA: Western World
INSURER B:
Rorby Landscape, LLC
Steve &orby
PO Box 909
Wellington CO 80549
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 ANYCONTRACT 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
INSFIN
TYPE OF INSURANCE
POLICY NUMBER
DATE MIDDC/YY
DATE MMIDDIYY)
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$ 1000000
A
X
X COMMERCIAL GENERAL LIABILITY
NPP0835066
11/09/04
11/09/05
PREMI$ESEaoccureF`ENTLunce
$100000
CLAIMS MADE ®OCCUR
MED EXP(Any one person)
S5000
PERSONAL 3 ADV INJURY
$ 1000000
-
GENERAL AGGREGATE
s 2000000
GEN'L AGGREGATE LIMB APPLIES PER:
PRODUCTS - COMP/OP AGG
$ 1000000
X POLICYJEGT LOC
AUTOMOBILE
LIABILITY
ANY AUTO
COMBINED SINGLE LIMB
(Ea accident)
$
BODILY INJURY
(Per Person)
$
ALL OWNED AUTOS
SCHEOULEDAUTOS
GODLY INJURY
(Par accident)
$
HIRED AUTOS
NON -OWNED AUTOS
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY -EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
1
$
AUTO ONLY: AGG
EXCESSIUMSRELLA LIABILITY
EACH OCCURRENCE
$
OCCUR CLAIMS MADE
AGGREGATE
$
Y
$
DEDUCTIBLE
$
RETENTION $
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETORlPARTNERIEXECUTIVE
70RY UMITS ER
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYEE
S
OFFICERIMEMBER EXCLUDED?
X yes, describe under
EL. DISEASE -POLICY LIMIT
I $
SPECIAL PROVISIONS WOW
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Landscape gardening. Products -completed cps are
subject to the General Agg limit
City of Port Collins small landscape & irrigation annual project bid #5924
are named as additional insured.
City of Pt. Collins
970-221-6707
John Stephens
P O Box 580 215 N Mason St 2nd
Port Collins CO 80525
CIPTCOC I SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAL 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
REPRESENTATIVES. / �-�
08/22/2005 09:21 9705687635
PAGE 02/03
CENTENNLAL INSURANCE GROUT
6901 SOLTH PIERCE STREET n233
LITTLETON, CO 80128
PHONE #720-962-8700 OR 1.866-962-8700
F.A,,X: K720-962-8800
REQUEST FOR CERTIFICATE OF INSURk'VCE
'URGENT:
4IMC:
M,�It1C O, LY IF 24-HOUR TURN.AROLTND IS NOT AUEQ,'.AT'
GENERAL LL 31LTY:
W ORK Coin': _ x
PROPERTY.
DATE OF REQUEST: 31z-2/-.0 5 . -
8:15 a.m.
AME OF COMPANY OR DBA:.,. xorby Landscag%,-LLC
NAMt OF PERSON MLrESTLNG C1ZRIVICATE Steve L. Korbv ,:_,...
PHON'ENL•MBER: 970-56.8--76 3.— --.-- —
SENT) TO CERTIFICATE BOLDER:
N.kME OF COMPANY:. City of Ft. —
STREET: 215 N. Mason --
PO BOX: P.O. Box 580
CITY- F't 1'nl 1 ins, STATE: CO _ _-ZIP;_ 0572----. . _..
ATT:ti: John Stgah na _PHONE: 970-221-6777
ADD AS .AL D70N.a.L INSURED: YES X_ CONTRACT AMOUNT $ Sn nnn, nn
NO
PROYECT: Small- Land-scape RroT,-t-
CHECK'; MAIL
FAX 4: ( 976 "�-6797
PL"e a$c KEEP N -WND'tllZ CENTLN"NIAL P SUP ANCE GROUP %7LL DO EVERYTHItiG POSSMLE TC
NrEPr" THE CO�NFCDENCE YOU HAVE ENTRUSTED IN US.