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HomeMy WebLinkAboutWAYNE DIRT WORK - INSURANCE CERTIFICATEACORD CERTIFICATE OF LIABILITY INSURANCE OP ID DATE(MM/DDIYYYY) WAYNE-1 06/01 09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Brown & Brown Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 125 S Howes, 5th Floor HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P O Box 2226 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Fort Collins CO 80522-2226 Phone:970-482-7747 Fax:970-484-4165 Wayne's Dirt Work Wayne Kontz dba PO Box 162 Bellvue CO 80512 COVERAGES INSURERS AFFORDING COVERAGE NAIC # INSURERA: Mountain States Mutual 14648 INSURER B: Pinnacol Assurance Company 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. INSRADd L LTR INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MMIDD POLICY EXPIRATION DATE MM/DD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1 , 000 , 000 A X X COMMERCIAL GENERAL LIABILITY CPP007279008 08/17/08 08/17/09 PREMISES(Eoccurence) $ 100,000 CLAIMS MADE X❑ OCCUR MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2 , 000 , 000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG s2,000,000 POLICY PRO- JECT LOC AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS 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 F—ICLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE - 4047562 06/01/09 06/01/10 W X TORY LIMITS ER E.L. EACH ACCIDENT $ 100000 E.L. DISEASE - EA EMPLOYEE $ 100000 OFFICER/MEMBEREXCLUDED? If yes, describe under E.L. DISEASE - POLICY LIMIT $ 500000 SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS City of Fort Collins is included as additional insured under the general liability. CERTIFICATE HOLDER CANCELLATION City of Fort Collins Purchasing 281 N College Avenue Fort Collins CO 80522 CITYFT5 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, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. ACVRU 25 (ZUollos) © ACORD CORPORATION 1988