HomeMy WebLinkAboutALTERNATIVE TURF LLC - INSURANCE CERTIFICATEOR, CERTIFICATE OF
LIABILITY INSURANCE OP ID CB DATE(MMIDD/YYYY)
-AC
TURFM-1 OS 29 09
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
LBN Insurance Agcy-Johnstown
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
4848 Thompson Pkwy, Ste 200
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Johnstown CO 80534
Phone: 970-635-9400 Fax:970-635-9401
INSURERS AFFORDING COVERAGE
NAIC#
INSURED
INSURERA: Colorado Casualty Insurance Co
INSURER B: Pinnacol Assurance
41190
Alternative Turf, LLC
----"------"-""""— -- --
-"---""---
dba Turf Master
INSURERC:
3327 Giddings Rd
4
INSURER D:
_
Fort Collins CO 80524
-----
--
INSURER E:
COVERAGES
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
LTR
DD'
NSR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE IMMi
POLEXPIRATION
ICY
DATE Judi
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
S $1 , 000 , 000
A
X COMMERCIAL GENERAL LIABILITY
CBP8594496
02/20/09
02/20/10
PREMISES(Eaoccureence)
_
S$100,000
CLAIMS MADE LXJ OCCUR
MED EXP(Any one person)
S $5 000
PERSONAL &ADV INJURY
S$1,000,000
GENERAL AGGREGATE
$$2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OPAGG
$$2,000,000
X POLICY PRCT O- LOC
JE
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
$ $1 OOO OOO
X
A
ANY AUTO
RA8593996
02/20/09
02/20/10
(Ea accident)
BODILY INJURY
$
ALL OWNED AUTOS
_
SCHEDULED AUTOS
(Per person)
X
BODILY INJURY
S
HIREDAUTOS
X
NON-OWNEDAUTOS
(Per accident)
PROPERTY DAMAGE
$
(Per accident)
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
S
ANYAUTO
N/A
OTHER THAN EA ACC
S
_
S
AUTO ONLY: AGO
EXCESSIUMBRELLA LIABILITY
EACH OCCURRENCE
S$1,000,000
A
X OCCUR nCLAIMS MADE
CU8601203
02/20/09
02/20/10
AGGREGATE
s$1,000,000
S
DEDUCTIBLE
X RETENTION $$10,00
S
WORKERS COMPENSATION AND
TORYLIMITS ER
B
EMPLOVERS'LIABILITY
4111868
06/01/09
06/01/10
—M --
E.L. EACH ACCIDENT
$100000
ANY PROPRIETOR/PARTNERIEXECUTIVE
OFFICERIMEMBER EXCLUDED?
E.L. DISEASE - EA EMPLOYEE
$ 1 OOOO O
If yyes, describe under
SPECIALPROVISIONS belm
E.L. DISEASE -POLICY LIMIT
'----
$500000
OTHER
_
_ _
N/A
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
CERTIFICATE HOLDER CANCELLATION
City of Fort Collins
Open Space -Natural Res
John Stokes
P.O. Box 580
Ft. Collins CO 80522
CITYFT3 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
Dept. IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
ACORD 25 (2001/08)
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.