HomeMy WebLinkAboutLARUEL HILL GIS - INSURANCE CERTIFICATEA.-CORP, CERTIFICATE OF LIABILITY INSURANCE DATEIM04/2MIDD/YY009VYI
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
4025 St. Cloud Dr. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
Suite 100 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Loveland, CO 80538 INSURERS AFFORDING COVERAGE NAIC #
INSURED LAUREL HILL GIS INC. INSURER Assurance Company of America 19305
307 BROSS ST INSURERS: Pinnacol Assurance 41190
LONGMONT, CO 80501-5427 INSURER0: Philadelphia Insurance Company 0238S0
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.
MSR
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TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
POLICY EXPIRATION
LIMITS
GENERAL LIABILITY
X COMMERCIAL GENERAL UABILITY
CLAIMS MADE X OCCUR
PPS037575108
02/01/2009
02/01/2010
EACHOCCURRENCE
$ 1,000,000
DAMAGET —RENTED
S-(Fa occ irenced
$ 1,000,000
MED EXP (Any one person)
$ 10,000
A
PERSONAL & ADV INJURY
$
GENERAL AGGREGATE
$ 2,000,000
GENT AGGREGATE LIMIT APPLIES PER
X POLICY PRO
PRO-JECT 7 LOC
PRODUCTS - COMP/OP AGO
S 2,000,000
AUTOMOBILE
LIABILITY
ANY AUTO
PPS037575108
02/01/2009
02/01/2010
COMBINED SINGLE LIMIT
(Ea accident)
$
1,000,000
BODILYINJURY
(Per person)
$
A
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON-OWNEDAUTOS
X
BODILY INJURY
(Per accident)
$
X
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
5
ANY AUTO
THAN EA ACC
$
AUTO ON
AUTO ONLY: AGO
$
EXCESSIUMBRELLA LIABILITY
OCCUR CLAIMS MADE
PPS037575108
02/01/2009
02/01/2010
EACH OCCURRENCE
$ 1'000,000
AGGREGATE
$ 1,000,000
A
$
DEDUCTIBLE
RETENTION $
$
WORKERS COMPENSATION AND
4091796
04/01/2009
04/O1/2010
X WCSTAIU- OTH-
EMPLOVERS' LIABILITY
E.L. EACH ACCIDENT
—
$ 1,000,000
B
ANY PROPRIETORMAIRTNER/EXECUTIVE
OFFICEWMEMBER F.XC! LIDLD9
If yes, describe under
E. L. DISEASE - EA EMPLOYEE
--'—'
$ 1,000,000
E.I.. DISEASE -POLICY LIMIT
$ 1,000,000
SPECIAL PROVISIONS be.
C
OTHER
Errors & Omissions
PHSD364559
10/26/2008
10/26/2009
$1,000,0000 each claim
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS
City of Fort Collins
Attn: John Stephens
PO BOX S80
Fort Collins, CO 80522
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
.+ W. u 40 j4VV NVol OACORD 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 (2001108)