Loading...
HomeMy WebLinkAboutDENNIS KNTZLEY ROCKY MOUNTAIN COATING - INSURANCE CERTIFICATE10/7/20(35 8:48 AM FROM: Fax TO: 2216775 PAGE: 001 OF 002 ACORD CERTIFICATE OF LIABILITY INSURANCE DATE IMMIDDNYYY) n" 10/07/2005 PRODUCER (970) 484-2805 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION John C. Sackett &Associates, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 220 Smith Street I ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Ft. Collins CO 80524- INSURERS AFFORDING COVERAGE INSURED INSURER A'. UNITED FIRE S CASUALTY Dennis Kintzley DBA: Rocky Mountain Coating INSURER 1542 Maple Street INSURER C 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. INSR LTR DO'L INSRO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE(MWDDWY) POLICY EXPIRATION DATE(MMIDDNY) LIMITS A GENERAL LIABILITY J J J J EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS MADE DOCCUR 60058378 09/21/2005 09/21/2006 PREMGE TO RENTED ISES Eaowuaemej $ 100,000 MEDEXP(Anyone person) $ 5,000 PERSONAL &ADV IWURY $ 1,060,000 GENERAL AGGREGATE $ 2,000,000 J J J J GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMPlOP AGG $ 2,000,000 X POLICY ACT LOC J J J I A AUTOMOBILE LIABILITY ANY AUTO J J J J COMBINED SINGLE LIMIT (Eaacciden0 $ 1,000,000 BODILY INJURY (Per person) $ X ALL OWNED AUTOS SCHEDULED AUTOS 60058378 09/21/2005 09/21/2006 X X HIREDAUTOS NON -OWNED AUTOS J J J J BODILY INJL BY (Per acudont) $ PROPERTY DAMAGE (Peraccident) $ J J J J GARAGE LIABILITY AUTO ONLY - EAACCIDENT $ OTHER THAN EAACC $ ANY AUTO NO COVERAGE J J J J $ AUTO ONLY'. AGO EXCESSIUMBRELLA LIABILITY NO COVERAGE J J J J EACH OCCURRENCE $ OCCUR ❑ CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE J / I I $ RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY NO COVERAGE aHH- I TORVLIMITS I I ER E.L. EACH ACCIDENT $ ANY PROPRIETORIPARTNER/EXECUTIVE E.L. DISEASE- EA EMPLOYEE $ OFFICER/MEMBER EXCLUDED? J J J I Ifyes, desaiheunder SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ OTHER NO COVERAGE DESCRIPTION OF OPERATIONSIIOCATIONSIVEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPEGAL PROVISIONS CERTIFICATE HOLDER CANCELLATION ( ) - (970) 221-6775 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 CITY OF FORT COLLINS FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE ACCOUNTING DEPARTMENT INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE - PO BOX 580 FORT COLLINS CO 90522-0580 1 ACORD 25 (2UU11U8) ©ACORD CORPORATION 1989 *,,- INS025 (01ow5 - ELECTRONIC LASER FORMS, INC .-(800)327-0545 Page 1 of 2 10/7/2005 8:48 AM FROM: Fax TO: 2216775 PAGE: 002 OF 002 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 Certficate 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. A{�CO RE) ZO (Z001103) OTI- INS025 (oios) o5 Page 2 of 2