HomeMy WebLinkAboutCARNES SERVICE - INSURANCE CERTIFICATEACORD.„
CERTIFICATE OF
LIABILITY INSURANCE
DATE(MMIDD/YYYY)
03/02/2006
PRODUCER (970) 484-2805
John C. Beckett &Associates, Inc.
220 Smith Street
Ft. Collins CO 80524-
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGH S UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOE NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
NAIC#
INSURED
Connie Carnes
PO Box 1258
Wellin ton
DBA: Carnes Service
CO 80549-
INSURERA:Burlington InsurancAI CO
INSURER B:Northland Insurance
INSURER C: Pinnacol Assurance
INSURER O:
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD I DICATED. NOTWITHSTANDING ANY
REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICAT 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
ADD'L
NSRD
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE (MMlDD7YY)
POLICY EXPIRATION
DATE (MM/DD1YY)
LIMITS
A
GENERAL LIABILITY
X GENERAL LIABILITY
CLAIMS MADE 1K OCCUR
210BR00033
% %
02/27/2006
/ %
02/27/2007
EACH OCCU RENCE
$ 1,000,000
RENTED
DAMAGCOMMERCIAL
PREMISESSa occurrence
PREMISES
$ 1,000,000
MEDEXP (Ady oneperson)
$ 5,000
PERSONAL A ADV INJURY
$ 1,000,000
GENERAL A GREGATE
$ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
X POLICY JECT LOC
PRODUCTS-COMP/OP AGG
$
B
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON-OWNEDAUTOS
CT129847
/ /
09/18/2005
/ /
/ /
09/18/2006
/ /
COMBINED SINGLE LIMIT
(Ea accident)
$ 1,000,000
BODILY INJUFY
(Per person)
$
X
BODILY INJU Y
(Per accident)
$
PROPERTY MAGE
(Per accident)
$
GARAGE LIABILITY
ANY AUTO
NO COVERAGE
/ %
% %
AUTO ONLY - A ACCIDENT
$
OTHER THAN EA ACC
AUTO ONLY: AGG
S
$
EXCESS/UMBRELLA LIABILITY
OCCUR CLAIMS MADE
DEDUCTIBLE
RETENTION $
NO COVERAGE
/ /
/ /
% %
/ /
EACH OCCUR ENCE
$
AGGREGATE
$
$
S
$
C
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETORIPARTNERIEXECUTIVE
OFFICERIMEMBER EXCLUDED?
It yes, describe under
SPECIAL PROVISIONS below
4056971
05/01/2005
/ /
05/01/2006
/ /
X I TORYUM S I OER
E.L. EACH ACCIDENT
S 1,000,000
E.L. DISEASE - A EMPLOYEE
$ 1,000,000
E.L. DISEASE- OLICY LIMIT
$ 1,000,000
OTHER
NO COVERAGE
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
CERTIFICATE HOLDER CANCELLATION I
SHOULD ANY OF THE ABOVE DESCRIBED POLIC S BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INS RER WILL ENDEAVOR TO MAIL
10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT
CITY OF FT.
COLLINS/STREETS DEPT .
FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION O LIABILITY OF ANY KIND UPON THE
PO BOX 580
INSURER, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE _._._----------,
FT. COLLINS
CO 80522-
ACORD 25 (2001/08)
qr, INS025 (0100).05
ELECTRONIC LASER FORMS, INC. - (800)327-0545
ACORD CORPORATION 1988
Page 1 of 2
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. Alstatement 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 polices may require an
endorsement. A statement on this certificate does not confer rights to the certificate hold r in lieu of such
endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract be ween the issuing
insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmati ely or negatively
amend, extend or alter the coverage afforded by the policies listed thereon.
ACORD 25 (2001108)
q1,: INS025 (of os).oe Page 2 of 2