HomeMy WebLinkAbout120528 FORT COLLINS TREE CARE - INSURANCE CERTIFICATEAS _.,)R-U, CERTIFICATE OF LIABILITY INSURANCE
PRODUCER (303)776-5122 FAX (303)776-5495 THIS CERTIFICATE IS ISSUED AS A MATTER OF
First Mai nStreet Insurance ONLY AND CONFERS NO RIGHTS UPON THE CE
512 4th Avenue HOLDER. THIS CERTIFICATE DOES NOT AMEND
P.O. Box 847 ALTER THE COVERAGE AFFORDED BY THE POI
DATE (MM/DD/YYYY)
EXTEND OR
Longmont, CO 80502 INSURERS AFFORDING COVERAGE NAIC #
INSURED Fort Collins Tree Care, Inc. INSURERA: Hartford Fire Insurance Co 19682
301 East Douglas Road INSURERS: Pinnacol Assurance
Fort Collins, CO 80524 INSURER
INSURER D:
INSURER E:
L91ftii;ISli] WI
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
DD'
OF INSURANCE
POLICY NUMBER
—POLTYPE
QAICVEFFECTIVE
PDATEi XPIRATION
LIMITS
GENERAL LIABILITY
34UUNSR3900
03/05/2008
03/05/2009
EACHOCCURRENCE
$ 1,000,000
X COMMERCIAL GENERAL LIABILITY
DAMAGE TO RENTED
$ 300.000
CLAIMS MADE IA OCCUR
MED EXP (Any one person)
S 10,000
A
PERSONAL & ADV INJURY
$ I 000, 000
GENERAL AGGREGATE
,
S 2,000,000
GENT AGGREGATE LIMIT APPLIES PER
PRODUCTS - COMP/OP AGO
$ 2,000 000
POLICY X ECT LOG
AUTOMOBILE
LIABILITY
34UUNSR3900
03/05/2008
03/05/2009
COMBINED SINGLE LIMIT
S
X
ANVAUTO
(Ea accident)
1,000,000
ALL OWNED AUTOS
BODILY INJURY
$
A
SCHEDULED AUTOS
(Per person)
X
HIRED AUTOS
BODILY INJURY
S
X
NON-OWNEDAUTOS
(Per accident)
PROPERTY DAMAGE
S
—
(Per accident)
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
ANY AUTO
OTHER THAN EA ACC
$
AUTO ONLY: AGG
S
EXCESSIUMBFELLA LIABILITY
EACH OCCURRENCE
S
OCCUR CLAIMS MADE
AGGREGATE
$
$
DEDUCTIBLE
$
RETENTION S
$
WORKERS COMPENSATION AND
4068879
OS/01/2008
O5/01/2009
X WC STATU-
B
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
4068879
0510112007
05/01/2008
E.L. EACH ACCIDENT
--
$ 100,000
OFFICEW'MEMSER EXCLUDED?
E.L. DISEASE - EA EMPLOYEE
5 100,000
Ryes, tlunder
EL DISEASE - POLICY LIMIT
S 500,000
SPECIALL PROVISIONS
VISIONS below_
--
---- —
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS
ity of Fort Collins as Additional Insured as required by written contract per General Liability policy
orm.
City of Fort Collins
P 0 Box 580
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
10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
Pat Deaver/MMM
ACORD 25 (2001/08) FAX:
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.
ACORD 25 (2001108)