HomeMy WebLinkAbout133608 ANLANCE PROTECTION LTD - INSURANCE CERTIFICATE (9)ACORDM CERTIFICATE OF LIABILITY INSURANCE
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PRODUCER (970)223-0924 FAX (970)267-2231
Colorado BW Insurance Agency, Inc.
1075 W Horsetooth Rd, Ste 106
Fort Collins, CO 80526
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
NAIC #
INSURED AnlFance Protection Ltd
PO Box 2401
Ft Collins, CO 80522
INSURERA: Everest Indemnity Ins Co
INSURERS: Pi nnacol Assurance
41190
INSURER C:
INSURER D:
INSURER E:
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
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TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
POLICY EXPIRATION
DATE Imminnim
LIMITS
GENERAL LIABILITY
51GL000975-081
07/13/2008
07/13/2009
EACH OCCURRENCE
$ 1100090001
MERCIAL GENERAL LIABILITY
DAMAGETO RENTED
$ 50,00CLAIMS
MADE OCCUR
MED EXP (Any one person)
$ 5,00A
I
PERSONAL & ADV INJURY
$ 1,000,00
GENERAL AGGREGATE
$ 2,000,00(
GEN-L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
$ 1,000,00
u POLICY 7 JPECOT LOC
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
$
ANY AUTO
(Ea accident)
BODILY INJURY
$
ALL OWNED AUTOS
SCHEDULED AUTOS
(Per person)
BODILY INJURY
$
HIRED AUTOS
NON -OWNED AUTOS
(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 FICLAIMS MADE
AGGREGATE
$
$
DEDUCTIBLE
$
RETENTION $
WORKERS COMPENSATION AND
4064145
01/01/2009
01/01/2010
a I WC STATU- OTH-
EMPLOYERS' LIABILITY
E.L. EACH ACCIDENT
$ 1,000,00C
B
ANY PROPRIETOR/PARTNER/EXECUTIVE
E.L. DISEASE - EA EMPLOYE
$ 11000,00(
OFFICER/MEMBER EXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE - POLICY LIMIT
$ 1,000,00(
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
he certificate holder is named as an Additional Insured with respect to the ongoing operations
f the Named Insured on the General Liability only.
City of Fort Collins
Finance & Purchasing Department
Attn: Christine Jarvis
215 N. Mason St., Second Floor
PO Box 580
Fort Collins, CO 80522-0580
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 N URER, ITS AGENTS
AUTHORIZED REPRESE T ^
Leslie Shade 0'd 1 9
ACORD 25 (2001/08) rAA: cci-oiui VAGUKU GUKNUKAI IUN IV750
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)