HomeMy WebLinkAboutRESOURCE ONE LLC - INSURANCE CERTIFICATEACORD,.CERTIFICATE OF LIABILITY INSURANCE CB34o108
DAT 17. /I05VI /200AY)
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
morecon s
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Deno B. Ulster sc., see. aeo
HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
Denver, co 9oz3'1
303-395-2300
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
NAIC#
INSURED
Resource One, LLC
INSURER A! Pnnnacol Assurance
I_—
dba 'terra Pinny
INSURER B:
coo Grant s8020C, Suite '!00
.__.. __.__.____ __._.._
Denver,
envex, 902 CO 03
INSURER C:
INSURER D
INSURERS
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FORTHE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECTTO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BYTHE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALLTHE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
I NSR ADD' _-- _ _ POLICY EFFECTIVE POLICY EXPIRATION _
LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MMIDDIYY DATE (MW0DNYJ LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
S
COMMERCIAL GENERAL LIABILITY
-DASMG=RENTE
S
❑OCCUR
PREMI SLS(Ea occurenqpl__,
CLAIMS MADE
MED EXP(Any one person)
S
_..__.
PERSONAL &AOV INJURY
S
GENERAL AGGREGATL
S
GEN'L AGGREGATE LIMIT APPLIES PER
PRODUCTS - COMPIOP AGG
$
POLICY PRO- LOC
_—----- __—__._..--
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
ANY AUTO
(Ea zcddeot)
S
ALL OWNED AUTOS
BODILY INJURY
SCI IIPDULED AUTOS
(Per person)
5
HIREDAUTOS
-....._...
--.._—.._..__
B INJURY
NON-OWNED AUTOS
(Peeer accident)
acoldani)
S
--
PROPERTY DAMAGE
(Perecddenp
S
GARAGE
LIABILITY
AUTO ONLY - EA ACCIDENT
S
ANY AUI'0
OTHCRTHAN CA ACC
S
AUTO ONLY: AGG
$
EXCESSIUMBRELLA LIABILITY
EACH OCCURRENCE.
S
OCCUR 171 CLAIMS MADE
AGGREGATL.
S
5
OEDUCIIBLE"—
-
S
RETENTION S
--... .---
S
p
WORKERS COMPENSATION AND
A038)l9
Ol./Ol /; OC4
01/01/201.0
X N1CSIATU OTH-
EMPLOYERS'LIABILITY
TQFY_LIG11jy 1;3_
ANY PROPRIETCIRPARTNELEXECUIVIr
E.L. EACH ACCIDENT
S 1.1000, 000
OFFICLRIMEMBER EXCLUDED?
Uyee. tle under
EL DISEASE - CA EMPLOYEES
-.--_I ---
1, 000, 000
—
PRO
SPECIAL PROVISIONS below
E.L. DISEASE -POLICY LIMIT
S 1, 000,000
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS (VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
This CerCifiCSLe SHOWS that H & 11 Da P.a Services, Inc. is covered under the workers' <enlpensat,ion policy issued to
Resource One, 1.LC dba 'Perry P:irma.
*10 Day noLice of cancellation will. be given for non-payment of premium.
City cf Port Collins
PO Rox 580
Port Collins, CO 80522-0580
25
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 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 INSURER, ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
Page 1 of 2 ve
� �"'.•••�.
Col
11'•C :►
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 (2001/08)