HomeMy WebLinkAboutMAT IVERSON MSI ENTERPRISES - INSURANCE CERTIFICATE04-12-2006 10:32 970351061E
PAGE:2
ACORDm
CERTIFICATE OF
LIABILITY INSURANCE
DATE(MWDDIY M
4/12 2006
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
827 11th By
Suite A
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Greeley, Co
80631
INSURERS AFFORDING COVERAGE
I INSURER AAtlantia Casualty Ineuraaca CompwLy
NAIC$
INSURED MATT IVERSON DBA
MSI ENTERPRISES, INC.
INSUHL:R B
2431
N SHIELDS ST
INSURER C:
INSURERD,
FORT COLLINS, CO 80524
970-217-9975
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT ON 01 HER DOCUMENT WITH RESPECT TO WHICH THIS CtR'IIFICA I t 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.
"alert AWL I .... - . _ POLICY EFFECTIVE FOLIC EXPIRATION
LTB NBIiD ry TINSURANCE POLICY NUMBER DATE MMIDDIYY DATE MAID LIMITS
GENERAL LIABILITY
EACH OCCURRENCE.
$ _ 1,000,000
8 COMMERCIAL GENERAL LIABILITY
DAMAGE TO RENTED
(Es mwpt")
$ 100 , 000
CLAIMSMADF f x I OCCUR
_PREMISES
MItUtXP(AnYonepersonT
S 5,000
A
ranmal
04/11/06
04/11/07
PERSONAL&ADVIN_JORY
$ 1,000,000
GF.NFRAt AGGREGATE
IT 1,000,000
GENT. ACOHhGAIL LIMIT APPLIES PER:
PRODUCTS - COMPIOP AGG
$ 1, 000, 000
x POLICY JE 7 LOC
AUTOMOBILE
LIABILITY
JEOBR�dNFmSINGI FIIM R
$
_
ANYALITO
ALL OWNED AUTOS
WUTLY INJUKY
SCHEDULED AU tUS
(Per person)
S
_
BODILY INJURY
S
HIRED AUTOS
NON-OWNWAUTOS
fYerBccvGent)
$
-
PROPERTY DAMAGE
IPermadent)
GARAGE LIABILITY
AUTO ONLY -EA ACCIDENT
$
ANYAOTO
OTIICRTIMN EAACC
S
S
AUTOONLY. AUG
FXCFSSNMBRELLA LIABILITY
EACH OCCURRENCE
$
OCCUR LI CLAIMSMAUF
AGGREGATE
IT
a
_ _
S
DEDUCTIBLE
6
RETENTION $
WORKFRS COMPENSATION AND
TORYLIMITS ER
CMPLOYERS' LLABLLITY
ANY PHOtw1ET0WAnTNFNF%FC..LRIVF
E.L. EACH ACCIDENT
__._... _...._
S ... ...
OFFICENMLMVLN LXILULNU'"
. E.L DISEASE - EA EMPLOY
S
Ilyeadev"IboUrlaer
-..-
..--'—"---------
SPECIAL PROVISIONS below
C.L. DISEASE - POLICY LIMI7
$
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY EN UOKStME NI I SPECIAL PROVISIONS
Excavation
Additional Insured
Attention: Ed Bonnette
City of Fort Collins
PO Box 580
Ft Collins, CO 80522-0580
FAX: 970-221-6707
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE 70EREOF, THE ISSUING INSURFR WLLL ENDEAVOR TO MAILl0 DAYS WRIT IEN
NOTICF TO TI IC CERTIFICATE HOLUEH NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OFANY KIND UPON THF. INSURER, ITS AGENTS OR
CORPORATION 1288