HomeMy WebLinkAboutCORRESPONDENCE - GENERAL CORRESPONDENCE - INSURANCEOP ID $A DATE (MM/DD/YYYY)
ACORD CERTIFICATE OF LIABILITY INSURANCE IDSEC2 06 24 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:97.0-635-9401 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURERA: Pinnacol Assurance 41190
INSURER B:
Security"Alarm Systems Inc DBA INSURERC:
Dictoguard Security System
914 1§th Street INSURER D:
Greeley, CO 80631
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.
LTR
NSR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE MM/DDIYY
POLICY EXPIRATION
DATE MMIDDIYY
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$
PREMISES (Ea occurence)
$
COMMERCIAL GENERAL LIABILITY
N/A
CLAIMS MADE EIOCCUR
MED EXP (Any one person)
$
PERSONAL & ADV INJURY
$
GENERAL AGGREGATE
$
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
$
POLICY PRO LOC
JECT
AUTOMOBILE
LIABILITY
ANY AUTO
N/A
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 '4CC
$
ANY AUTO
N/A
$
AUTO ONLY: AGG
EXCESS/UMBRELLA LIABILITY
EACH OCCURRENCE
$
OCCUR ❑ CLAIMS MADE
N/A
AGGREGATE
$
$
DEDUCTIBLE
$
RETENTION $
WORKERS COMPENSATION AND
it RY LIMITS ER
TO
A
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
1970130
07/01/09
07/01/10
E.L. EACH ACCIDENT
$1,000,000
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
OFFICERIMEMBER EXCLUDED?
If yes, describe under
"SPECiAL"PRGViSIONS below-
-
E.L. DISEASE - POLICY LIMIT
- -
i $ 1 , U Ou , OuU
OTHER
N/A
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
('FRTIFIrATF s4ni IIFR CANCELLATION
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
City of Fort Collins
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
P.O. BOX 580
REPRESENTATIVES.
AUT IZ�b �E�RESE ATIV
Ft. Collins, CO 80522
ACORD 25 (2001/08) 10 AIA, KU L.UKrUKAI lvn lyaa
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)