HomeMy WebLinkAbout120528 FORT COLLINS TREE CARE - INSURANCE CERTIFICATE (3)A -QW,, CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DDjYYYY)
1 03/03/2009
PRODUCER (303)776-5122 FAX (303)776-5495
First Mai nStreet Insurance
512 4th Avenue
P.O. Box 847
Longmont, CO 80502
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 Fort Col I i ns Tree Care, Inc.
301 East Douglas Road
Fort Collins, CO 80524
INSURER A: Hartford Fi re Insurance Co
19682
INSURERB: Pinnacol Assurance
INSURER a
INSURER D:
INSURER E:
COVFRAQFS
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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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
D'
TYPEOFINSURANCE
POLICYNUMBER
POLICYEFFECTIVE
POLICYEXPIRATION
LIMITS
GENERALLIABILITY
34UUNSR3900
03/05/2009
03/05/2010
EACH OCCURRENCE
$ 1/000100
MERCIAL GENERAL LIABILITY
DAMAGE TO RENTED
$ 300,0001
CLAIMSMADE �OCCUR
MED EXP (Any one person)
$ 10 00A
N
PERSONAL & ADV INJURY
$ 11000100(
GENERAL AGGREGATE
$ 2, 000
GEN'L AGGREGATE UMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
$ 2,000,00(
X POLICY PRO LOC
JECT
AUTOMOBILE LIABILITY
X ANYAUTO
34UUNSR3900
03/05/2009
03/05/2010
COMBINED SINGLE LIMIT
(Ea accident)
$
1,000,00
BODILY INJURY
(Per person)
$
A
ALL OWNED AUTOS
SCHEDULED AUTOS
X HIRED AUTOS
X NON -OWNED AUTOS
BODILYINJURY
(Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
$
AUTO ONLY: AGG
EXCESS/UMBRELLA LIABILITY
EACH OCCURRENCE
$
OCCUR a CLAIMS MADE
AGGREGATE
$
$
DEDUCTIBLE
$
RETENTION $
WORKERS COMPENSATION AND
4068879
O5/01/2008
05/01/2009
X WCSTATIT FR
B
EMPLOYERS' LIABILITY
ANY PROPRI ETOR/PARTNERJEXECUTIVE
E.L. EACH ACCIDENT
$ 100,
E.L. DISEASE - EA EMPLOYE
$ 100, ON
OFFICERIMEMBER EXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
I DISEASE - POLICY UMIT
$ 500 00
OTHER
D€SCRIPTI N OF OPERATIO $ / LOCATIONS/ VEHICLES / EXCLUSIONS ADDED BY ENDOR§EMENT SPECIAL PROVISIONS
City o Fort Col ins as Additional Insured as required Eby written contract per General Liability policy
form.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
City of Fort Collins BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
P 0 BOX 580 OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
Fort Collins, CO 80522 AUTHORIZED REPRESENTATIVE —�
Pat Deaver
ACORD 25 (2001/08) FAX: (970)221-6707 CACORD 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)