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HomeMy WebLinkAboutWAG Z TIP SHOP AND TILE INC VERNS CUSTOM COUNTERT - INSURANCE CERTIFICATEACORD CERTIFICATE OF LIABILITY INSURANCE TM DATE /D) 06/086/08/20092009 PRODUCER (970)679-7333 FAX (970)679-7377 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Ewing -Leavitt Insurance Agency 4025 St . Cloud Dr. . ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Suite 100 Loveland, CO.80538 INSURERS AFFORDING COVERAGE _ NAIC#_ INSURED Wag • Z -Top Shop &--Tile, -Inc. - INSURERA: Colorado Casualty = " =.-.. ' - 41785.. .. _ DBA':-Vern's--Custom Countertops & Flooring INSURERS: Pinnacol Assurance'° 690 Cai rnes Dr. Fort Collins ;' "CO 80524-4032 INSURER C: INSURER D: INSURER E: Cn%/9PA(_FC 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. INSR ADD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE rj] OCCUR X Bl kt Addtl Insd CBP8571120 12/07/2008 12/07/2009 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (En onnurpmnp) $ 300,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 X Bl kt Waiver of Sub GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: POLICY X PRO JECT LOC PRODUCTS - COMP/OP AGG $ 2,000j000 A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS - . NON -OWNED AUTOS `' BA8570320 ... " ' - 12/07/2008 •. '• ' •' 12/07/2009 -- - COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X BODILY INJURY (Per person) $ X BODILY INJURY (Per accident) $ X PROPERTY DAMAGE (Per accident) .'."'-.-..GARAGE LIABILITY_----....; .:.�_:.� ` ANY AUTO _ _-_...._----._.._ ..___.... _._ ._ _.. ...._ _.•�- ._._' .. '.AUTOONLY-EAACCIDENT-. $._ _.._:_.... .... _. OTHER THAN EA ACC AUTO ONLY: AGG $ $ EXCESS/UMBRELLA LIABILITY OCCUR ❑ CLAIMS MADE DEDUCTIBLE RETENTION $ EACH OCCURRENCE $ AGGREGATE $ $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE—E.L. OFF'CER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below 4070834 07/01/2009 07/01/2010 X WC sTATU- OTH- TORY LIMITS I ER EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYEE $ 100,000 E.L. DISEASE - POLICY LIMIT 1 $ 500,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS City of Fort Collins Facilities Building 835 Wood St. Fort Collins, CO 80521 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 Toni Garcia ACORD 25 (2001/08) ©ACORD 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)