HomeMy WebLinkAboutWESTERN STATES LAND SERVICES - INSURANCE CERTIFICATE (2)ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID JS DATE (MMIDD/VYYY)
WEST E-1 12 09 08
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Richards, Seeley, & Schaefer, ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
3640 W. 112th Avenue ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Westminster CO 80031
Phone:303-429-3561 Fax:303-427-0611 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: American States Insurance
INSURER B: Pinnacol Assurance
Western States Land Services INSURER C:
505 N Denver Avenue INSURER D
Loveland CO 80537 - ------ -- --- .._._—_ ___
INSURER E:
'.M*111a:I_T"=
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.
LTR
O`
NSR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE MMIDD/YY
POLIO-S'EXPIRATION
DATE MM/DDIYY
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
A
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE LX l OCCUR
02B088794500
12/15/08
12 /15/09
"DAMAGET(EaENTED"_.__0
PREMISES (Ea occurence)
$ 250, ODD
MED EXP (Any one person)
$ 10,000
PERSONAL &AOV INJURY
$ 11000,000
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS - COMP/OP AGG
$ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
_.
PRO-
POLICY 71JECT LOCI
A
AUTOMOBILE
LIABILITY
ANY AUTO
02CD15012460
01/30/09
01/30/10
COMBINED SINGLE LIMIT
accident)
$ 1,000000(Ea
X
---
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
X
X
HIREOAUTOS
NON -OWNED AUTOS
BODILY INJURY
(Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
--- � � -
OTHER THAN EA ACC
--
$
ANY AUTO
AUTO ONLY:
AGG
$
EXCESSIUMBRELLA LIABILITY
EACH OCCURRENCE
$
OCCUR �, I CLAIMS MADE
AGGREGATE
$
DEDUCTIBLE
$
RETENTION $
B
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
1803222
01/01/09
01/01/10
X TORY LIMITS ER
--- TQ ------
E.L.EACHACCIDENT
--
$100,000
_..
E.L. DISEASE- EA EMPLOYEE
—
$ 100,000
OFFICER/MEMBER EXCLUDED?
If yes, describe under
— ---
E.L. DISEASE -POLICY LIMIT
$500,000
SPECIALPROVISIONSbelow
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
City of Ft. Collins
Mr O'Neil
PO Box 580
Ft. Collins CO 80522-0580
C�L•L`LN��9ilYH]PI
CITY019 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATI01
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 50 SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
ACORD 25 (2001108)