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HomeMy WebLinkAboutGROWLING BEAR - INSURANCE CERTIFICATE4C0Ro. CERTIFICATE OF LIABILITY INSURANCE OP ID RC DATE(MM/DDKYYY) GROWL-3 06 16 O8 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE LEN Insurance Agency HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 4848 Thompson Pkwy ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Johnstown CO 80534 Phone:970-635-9400 Fax:970-635-9401 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA'._._ Employers Mutual INSURER 8: Pinnacol Assurance Growling Bear Co., Inc. INSURER C: 2330 Ave. Greeley INSURER D: Greeleyey CO 80631 ............ INSURER E: VVVGKAbCJ 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. INS LTR D NSR __.._. -__.__ TYPE OF INSURANCE __ ___.____. _ ---PEFFECTIVE POLICY NUMDER GATE MMIDD/YY POLICY EXPIRATION DATE MMIDD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $1,000,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS MADE X OCCUR OD96522 07/31/07 07/31/08 -DAMAGETMRENTED PREWSES(Eaoccmenoe) $100,000 MED EXP(Any one person) $ 5,000 X Blanket Addrl PERSONAL B ADV INJURY $1,000,000 X Blkt Waiver GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OPAGG $2,600.000 POLICY X PRO JECT LOC A AUTOMOBILE LIABILITY ANY AUTO OE96522 07/31/07 07/31/08 CO accident) (EaCOMBINED SINGLE LIMIT g 1 O0O OOO r r X - ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per person) IS X HIRED AUTOS NON -OWNED AUTOS BODILY INJURY (Per accident) $ X ----- ---- --- PROPERTY DAMAGE (Per accident) $ LIABILITY AUTO ONLY - EA ACCIDENT $ hAGE ANY AUTO O _ OTHER THAN EA ACC $ $ AUTO ONLY: AGG A EXCESS/UMBRELLA LIABILITY X OCCUR CLAIMS MADE OJ96522 07/31/07 07/31/08 EACH OCCURRENCE $5,000,000 AGGREGATE s5,000,000 $ DEDUCTIBLE RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS -LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? �f yas, dernibe under SPECIAL PROVISIONS below 1436910 07/01/08 07/01/09 - X_TORY LIMITS___ ER E.L. EACH ACCIDENT _ $1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1 , 000 , 0 00 -- -- El, DISEASE -POLICY LIMIT $1 00O 000 OTHER A Installation OC96522 07/31/07 07/31/08 Any 1 Loc $1,500,000 Floater Ded $500 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS ALL Operations - All Locations OCIK I IrRlA l e nIULuelc CANCELLATION CITYFTC 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 DO SO SHALL City of Fort Collins IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 215 North Mason REPRESENTATIVES. Fort Collins CO 80525 AUr IP0 j(EVRESE0ATiVjm. 25 (2001108) ©ACORD 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. 25