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HomeMy WebLinkAboutWAG Z TOP SHOP AND TILE - INSURANCE CERTIFICATEA RD CERTIFICATE OF LIABILITY INSURANCE 12122/zoos) PRODUCER (970)679-7333 FAX (970)679-7377 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Ewing -Leavitt Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 4025 St. Cloud Dr. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Suite 100 Loveland, CO 80538 INSURERS AFFORDING COVERAGE NAIC # INSURED Wag Z Top Shop & Ti 1 e, Inc. INSURER A: Colorado Casualty 41785 DBA: Vern's Custom Countertops & Flooring INSURERB: Pinnacol Assurance 690 Cai rnes Dr. INSURER C: Fort Collins, CO 80524-4032 INSURE_RD. INSURER E: rr)VFRAnPR 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 ADD1 TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DATE fMM/DD/YY) LIMITS GENERAL LIABILITY CBP8571120 12/07/2008 12/07/2009 EACHOCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS MADE a OCCUR DAMAGE- TO REN"FED _YBEfv11SE5_fEa-eccucencel $ 300,000 MED EXP (Any one person) $ 10,000 A X Bl kt Addtl Insd PERSONAL & ADV INJURY $ 1,000,000 X Bl kt Waiver of Sub GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY X JECT PRO LOC AUTOMOBILE LIABILITY ANY AUTO BA8570320 12/07/2008 -12/07/2009 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X A ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS BODILY INJURY (Per person) $ X BODILY INJURY (Per accident) $ X PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER I I IAN EA ACC $ ANY AUTO $ AUTO ONLY: AGG EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR ❑ CLAIMS MADE AGGREGAI"E $ $ DEDUCTIBLE $ RETENTION $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE 4070834 07/01/2008 07/01/2009 X WCSTATU- OTH- S OF3LLlMLLS_ �B L. F.EACH ACCIDENT $ 100,000 _ E.L. DISEASE - EA EMPLOYEE $ 100,000 OFFICER/MEMBER EXCI_UDEDZ If yes, describe under " SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT I $ 500,000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS City of Fort Collins Facilities Building 835 Wood St. Fort Collins, CO 80521 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 MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE IOT�A�.. Ashley Pabst/ASHLEY ACORD 25 (2001/08) ©ACORD CORPORATION 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. ACORD 25 (2001/08)