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Home My WebLink AboutAMERICAN PALLET AND TRAILER SPRAY OUT - INSURANCE CERTIFICATEFEB-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 Location of operations PO BOX 1391 CASTLE ROCK, CO 80104-1391 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 b.lnnl In -1116n In. ----I..n lnnn -A n ndl6nnn ni 16nnn nnll:nn Irk- I;-;.- nF Ilnhlll,., n6n.un m , kv - k--- -A.—A hu o oiA rlol— oo„ IF- -IIua U-1-1-1 m,u —IU IL —I �, LI I— a c-a. 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POLICY PERIOD LIMITS OF LIABILITY POLICY NUMBER TYPE OF INSURANCE Effective Date Expiration Date at beginning of policy period) Comprehensive BODILY INJURY AND 96-J4-6611-1 Businessiabilit 01-07-09 01-07-10 PROPERTY DAMAGE This insurance includes: ® Products - Completed Operations ® Contractual Liability ❑ Underground Hazard Coverage Each Occurrence $ 1_, 000, 000 ❑ Personal Injury ❑ Advertising Injury General Aggregate $ 2, 000, 000 ❑ Explosion Hazard Coverage Products - Completed ❑ Collapse Hazard Coverage Operations Aggregate $ 2 , 000 , 000 ❑ General Aggregate Limit applies to each project El POLICY PERIOD BODILY INJURY AND PROPERTY DAMAGE EXCESS LIABILITY Effective Date Expiration Date (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 PERIOD LIMITS OF LIABILITY POLICY NUMBER TYPE OF INSURANCE Effective Date Ex iration Date at be innin of policypatio 0671264F2306 AUTO INSURANCE 12 23/08 06 23 09 $1,0001000 Name and Address of Certificate Holder CITY OF FORT COLLINS PO BOX 580 FORT COLLINS, CO 80522-0580 If any of the described policies are canceled before its expiration date, Stale Farm will try to mail a written notice to the certificate holder 30 days before cancellation. If, however, we fail to mail such notice, no obligation or liability will be imposed on State Farm or its agents or representative Signature of Authorized epresentalive C71 PWk Title 558-994 a 2-90 Printed in U S A Date 02/19/2009 10:35AM Pinnacol Assurance PAGE 1 OF 3 PINNAS COL ASSURANCE Date 02/19/2009 To AMERICAN PALLET AND TRUCK WASH LLC Fax Number 970-221-6707 From Customer Service Phone Number 303-361-4007 Subject Document UW135 28349639 Policy # 4114186 Total Pages 3 Notes Please contact us if you did not receive any portion of this transmission 7501 E Lowry Blvd Denver, CO 80230-7006 Phone 303-361-4000 www pinnacol com The information contained in this telecopy transmission is confidential or privileged and is intended to be for the use of the individual or entity named on this transmission sheet. If you are not the intended recipient. be aware that any disclosure. copying. distribution or use of the contents of this telecopied information is prohibited. If you have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the retrieval of the original transmission. 02/19/2009 10:35AM Pinnacol Assurance PAGE 2 OF 3 ACOR '" CERTIFICATE OF LIABILITY INSURANCE °ATE(MM/YYy 02/1W200200yg 9 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# iNSUREO ENSURERA PINNACOL ASSURANCE 41190 AMERICAN PALLETAND TRUCK WASH LLC INSURERS 3700 Canal Dr No,-RER C. Fort Collins, CO 80524 INSURER D. NBURER 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 ADD'L FOL Cy EFFECT NE FO CY EXF RATION _TR iNSRD TYPE OF, NBURANCE FO ICY NUMSER GATE,MMIDDPTYYY, DATE,MMIDDIYYrv, uMTS GENERAL LIABILITY EACn OCCURRENCE 5AMAOE TO FENTEO COMMEROA_ GENERAL UAS - TY C1 MS MADE OCCUR PREMISES MED EXFN%one aevom FERSONALSADV nwRY GEM_AGGREGATE - M T AFFUERS PER GENERA -AGGREGATE PRODUCTS-COMP/OFAGO 10-CY FRWECT LOC AUTOMOBILE LIABILITY COMB'. NED 8'. NG'_E - M'.T ANYAUTO Bee" enn BODILY inwRY Al OWNED AUTOS, SCTEDULED AUTOS, Fer aevom BOOT_ Y iN_RY M RED AUTO$ NON -OWNED AUTOS, Pare, enn PROPERTY DAMAGE Peracccenp GARAGE LIABILITY A. TO ON'_Y - EA. ACC'. DENT TTAN EAACC ANYA-TOOTTER A- TO ON-' AG EXCEHUMERELLA UABILITT EMN OCCURRENCE AGGREGATE OCCUR OJaMSMADE 0E0_CT'. B'_E RETENTION S WORKER8 COMPENSATION AND STAT_- Lj OTTER A EMPLOYER 8 LIABILITY ANY FROFRPo ETORIPARTNERIEXEDUTIVE 4114186 06/01/2008 0&0112009 TORY M TS E EACT ACC DENT $r00000 OFF i CER/MEMSER EXO__0E01 E n_0SEASE-EAEMI LOYEE $100000 ?yes IF ease aescr o,naerSFECA_P F GV SONS oei Ow E n_OSEASE-FOUCYUMT $500000 OTHER DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLESrEXCLUSIONS ADDED BY ENDORSEMENVSPECIA PROVISIONS CERTIFICATE HOLDER CANCELLATION 1134980 SHOULD ANY OF THEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Fort Collins Atten: John Stephens 215 North Mason Street Fort Collins CO 80521 THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR T MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO TH LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OI LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Aunaria 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, CO80524 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.