Loading...
HomeMy WebLinkAboutJAN PETERSON - INSURANCE CERTIFICATE6/15/2006 10:52 AM FROM: JCB Beckett _Associates TO: 2216707 PAGE: 002 OF 003 ACORD� CERTIFICATE OF LIABILITY INSURANCE DATE (MMA)D 06/15/2 6 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 RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC# INSURED Peterson, Jan 39234 Scenic View Court Ault CO 80610- INSURERA'GABNITE INSURANCE INSURER INSURER C. INSURER D INSURER 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 LTRNSRDOATE(MMADfYY) ADD'L TYPE OF INSURANCE POLICY NUMBER EFFECTIVE PATE(MMIDDIYY) POLICYOLICY LIMITS A GENERAL LIABILITY / / / / EACH OCCURRENCE $ 500, 000 GETO PREMISES Ea ocwE ence $ 100,000 X COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR PAC6586954 06/07/2006 06/07/2007 MED EXP(Any one person) $ 5,000 PERSONAL &ADV INJJRY $ 500,000 GENERAL AGGREGATE $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGO $ X POLICY ,ERCT LOC AUTOMOBILE LIABILITY ANY AUTO NO COVERAGE / / / / COMBINED SINGLE LIMIT (Ea awdent) $ BODILY IN URY (Per person) $ ALL OVVNED AUTOS SCHEDULED AUTOS / / / / BODILY INJJRY (Per accident) $ HIREDAUTOS NON-ONNED AUTOS / / / / PROPERTY DAMAGE (Per acaoent) $ GARAGE LIABILITY AUTO ONLY - EAACCIDENT $ OTHER THAN EA ACC $ ANY AUTO NO COVERAGE / / / / $ AUTO ONLY. AGG EXCESSAIMBRELLA LIABILITY NO COVERAGE / / / / EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE / / / / $ RETENTION $ WORKERS COMPENSATION AND NO COVERAGE / / / / TORY LIM- IMITS ER EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ E.L. DISEASE- EA EMPLOYEE $ OFFICER/MEMBER EXCLUDED? / / / / If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE- POLICY LIMIT $ OTHER NO COVERAGE DESCRIPTION OF OPERATIONSA.00ATIONSfVEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS (970) 221-6760 (970) 221-6707 ATTN: JMMS B O'VEIL City of Fort Collins PO Box 580 281 North College Avenue Fort Collins CO 80522- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 010 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 AUTHORIZED REPRESENTATIVE , A{ACORD 25 (2001/08) ©ACORD CORPORATION 1988 *, - INS025 (01os).05 ELECTRONIC LASER FORMS, INC .-(800)327-0545 Page I of 2 6/15/2006 10:52 AM FROM: JCB Beckett _Associates TO: 2216707 PAGE: 003 OF 003 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 Certificate 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{�CORD 25 (2001108) *- I NS025 )oioa) os Page 2 of 2