The URL can be used to link to this page

Home My WebLink About441289 AMERICAN POWER WASH - INSURANCE CERTIFICATE (2)FEB-19-2009 09:20A FROM:ROB VOYVODIC STATE F 3036931666 TO:101033319702216707 P.1/1 CERTIFICATE OF INSURANCE This certifies that ® STATE FARM FIRE AND CASUALTY COMPANY, Bloomington, Illinois ❑ STATE FARM GENERAL INSURANCE COMPANY, Bloomington, Illinois insures the following policyholder for the coverages indicated below: Name of policyholder AMERICAN PALLET & TRAILER SPRAY OUT, LLC Address of policyholder PO BOX 1391 CASTLE ROCK, CO 80104-1391 - Location of operations 3700 CANAL DRIVE FORT COLLINS, CO 80524 Description of operations The policies listed below have been issued to the policyholder for the policy periods shown. The insurance described in these policies is subiect to all the terms exclusions and rnnditinns of thnse nnliries The limits of liahility shown may haves been reduced by nnv naid claims_ POLICY NUMBER TYPE OF INSURANCE POLICY PERIOD LIMITS OF LIABILITY Effective Date Expiration Date at beginning of policy period) Comprehensive BODILY INJURY AND 9 6 - J4 - 6 611-1 Business Liabili 01- 0 7 - 0 9 101-07-10 PROPERTY DAMAGE This insurance includes: ® Products - Completed Operations ® Contractual Liability ❑ Underground Hazard Coverage Each Occurrence $ 1, 0 0 0 , 000 ❑ Personal Injury ❑ Advertising Injury General Aggregate $ 2, 0 0 0, 0 0 0 ❑ Explosion Hazard Coverage Products - Completed ❑ Collapse Hazard Coverage Operations Aggregate $ 2 , 0 0 0 , 0 0 0 ❑ General Aggregate Limit applies to each project El EXCESS LIABILITY POLICY PERIOD BODILY INJURY AND PROPERTY DAMAGE Effective Data Expiration Data (Combined Single Limit) ❑ Umbrella Each Occurrence $ ❑ Other Aggregate $ Part 1 STATUTORY Part 2 BODILY INJURY Workers' Compensation and Employers Liability Each Accident $ Disease Each Employee $ Disease - Policy Limit $ POLICY NUMBER TYPE OF INSURANCE POLICY PERIOD Effective Date Expiration Date LIMITS OF LIABILITY at beginning of policy period) 0671264F2306 AUTO INSURANCE 12 23/08 06 23 09 1 000 000 Name and Address of Certificate Holder CITY OF FORT COLLINS PO BOX 580 FORT COLLINS, CO 80522-0580 558-894 a 2-90 Printed in U S A It any of the described policies are canceled before its expiration date, State Farm will try to mail a written notice to the certificate holder 3 0 days before cancellation. If, however, we fail to mail such notice, no obligation or liability will be imposed on Stale Farm or its agents or representatives. Signature of Authorized epresentative A Title_ Date 02/19/2009 10:35AM Pinnacol Assurance PAGE 2 OF 3 ACO -T CERTI1 :ATE OF LIABILITY INSURA DATE0218 _.JCE 009Y1 PRODUCER PINNACOL ASSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY 7501 E Lowry Blvd Denver, CO 80230-7006 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 AMERICAN PALLET AND TRUCK WASH LLC INSURERA: PINNACOL ASSURANCE 41190 INSURER B: 3700 Canal Dr INSURER 0: Fort Collins, CO 80524 INSURER O: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDNG ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMMENT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADVL POLICY EFFECTIVE POJCY EXPIRATION LTR INSRO TYPE OF INSURANCE POLICY NUMBER DATESMM/DO/YYYYI DATEIMM/DD/YYYYI LIMITS GENERAL LIABILITY EACH OCCURRENCE DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY CLVMSMADE OCCUR PREMISES MED EXFV1ny one person) PERSONAL& AOV INJURY GENL AGGREGATE LIMIT APPLIERS PER: GENERAL AGGREGATE PRODUCTS - COMP/OP AGO POLICY 7 PROJECT LOC AUTONIOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO IEa Accltlmp BODILY INJURY ALL OWNED AUTOS SCHEDULED AUTOS {Perpe -) BODILY INJURY HIRED AUTOS NON -OWNED AUTOS IP er acddent) PROPERTY DAMAGE 4P er acc ident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT OTHER THAN EA ACC ANYAUTO AUTO ONLY: AGG EICEISNNBRELLA LIABILITY EACH OCCURRENCE AGGREGATE OCCUR CLAMS MADE DEDUCTIBLE RETENTION $ WORKERS CONPENBATION AND WC 9TAPt OTHER A EMPLOYER'S LIABILITY ,ANY PROPRIETOR/PARTNER/EXECUTIVE 4114186 06/01/2008 06/0112009 TORV LIMITS E.LEACHACCIOENT $100,000 OFFICER/MEMBER EXCLUDED' E.LOISEASE-EAEMPLOYEE $100.000 If yes, please tlescnbe untler SPE CIAL PRWISION9 below E.LOISEASE-P000YLIMIT $500,000 OTHER DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION 1134980 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Fort Collins THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR T Atten: John Stephens 215 North Mason Street Fort Collins CO 80521 MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO TH LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Aundria Martin ACORD 25(2001108) Underwriter ACORD CORPORATION 1988 02/19/2009 10:35AM Pinnacol Assurance PAGE 3 OF 3 POLICY HOLDER COPY AMERICAN PALLET AND TRUCK WASH LLC 3700 CANAL DR FORT COLLINS, CO 80524 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.