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HomeMy WebLinkAboutHEIMBUCK DISPOSAL - INSURANCE CERTIFICATE (2)xi M9. CERTIFICATE OF LIABILITY INSURANCE OPID MM DATE(MMIDDIYYYY) I HEIMB-1 11 05/08 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Renaissance Insurance Group HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 631 Birch Street, Unit D ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Windsor CO 80550 Phone:970-674-8825 Fax:970-674-8826 INSURERS AFFORDING COVERAGE NAIC# INSURED _ -_--"' ------ INSURER A. Allied Insurance Company INSURERS Pinnacol Assurance Heimbuck Disposal, Inc. ---- -- --- --- ___ Tim Heimbuck INSURER -- PO Box 270310 Fort Collins CO 80527 INSURER D 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. POLICY EFFECTIVE- POLICY EXPIRATION -- _-'- --'- ""-----'--'-- POLICY NUMBER DATE WMIDD/YV DATE IMMID D/YVI LIMITS LTR NSR TYPE OF INSURJAPFLIeSPER GENERAL LIABILITY EACH OCCURRENCE $1,000,000 A }[ COMMERCIAL GENECPMCT07531662675 11/Ol/08 11/Ol/09 DAMAGETO RENTED PREMISES occurence) -'-- $100,000 CLAIM$ MADE MED EXP (Any one person) $ 5 , 000 PERS014AL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $2,000,000 SENT AGGREGATE LIMIT PRODUCTS COMP/OP AGO $2, OOO, QQO POLICY $ jECT LO0 AUTOMOBILE LIABILITY -- A ANY AUTO ACPBA7531662675 11/01/08 11/01/09 ( COMBINED INGLE LIMIT § 1, 000, 000 ALL OWNED AUTOS X SCHEDULED AUTOS BODILY INJURY (Per person) $ X HIRED AUTOS .._.____ X NON -OWNED AUTOS BODILY INJURY (Per (Per accident) PROPERTY DAMAGE § (Per aceidenl) GARAGE LIABILITY — AUTO ONLY - EA ACCIDENT $ ANY AUTO N/A OTHER THAN EA ACC $ AUTO ONLY: AGO $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE S OCCUR r _.) CLAIMS MADE N/A AGGREGATE § $ DEDUCTIBLE __.1 j $ RETENTION 5 § WORKERS COMPENSATION AND A t. B EMPLOYERS' LIASILITV X ITORY LIMITS --, ER ANY PROPRIETOR/PARTNER/EXECUTIVE 4125234 08/01/08 08/01/09 EL EACH ACCIDENT $500,000 OFFICER/MCMBFR EXCLUDED? ---- ---- Ifyes, describeunder EL DISEASE EA EMPLOYEE $500,000 SPECIAL PROVISIONS below E L DISEASE POLICY LIMIT S 500 OOO OTHER , DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES / EXCLUSIONS ADDED BV ENDORSEMENT / SPECIAL PROVISIONS CFRTIFICATG Wnl nCD FTCPURC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN City Of Fort Collins NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Purchasing Division Attn : Ed Bonnette IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR P.O. BOX 580 REPRESENTATIVES. Fort Collins CO 80525 AUTHORIZED REPRESENTATIVE J ACORD 25 (2001/08) ©ACORD Q, ORATION 1988 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. 251200110M NOTEPAD: HEDM INSURED'S NAME Hembuck Disposal, OP ID MM This Certificate of Insurance represents coverage in effect and may or may not be in compliance with any written contract. The following cancellation conditions always apply: - 10 days for non-payment of premium - If policy shown, 10 days for Workers' Compensation for fraud; material misreprensentation, non-payment of premium; other reasons approved by the commissioner of insurance.