HomeMy WebLinkAbout133608 ANLANCE PROTECTION LTD - INSURANCE CERTIFICATE (6)COLORADO-BW INSURANCE Fax 19702672231 Jul 20 2009 04:54pm P001/002
AC-ORA, CERTIFICATE OF LIABILITY INSURANCE 0712012 0
PRODUCER (970)223-0924 FAX (970)267-2231 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Colorado 8W Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
1075 W Horsetooth Rd, Ste 106 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Fort Collins, CO 80526
INSURERS AFFORDING COVERAGE NAIC #
INSURED An ante Protection Ltd INSURERA: Everest Indemnity Ins Co
PO Box 2401 INsuRr�R6 Pinnacol Assurance 41190
Ft Collins, CO 80522 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.
INSR
DO'
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE
POLICY EXPIRATION
LIMITS
j
GENERAL LIA811-tTY
51CL000975-091
07/13/20091
07/13/2010
EACH OCCURRENCE
S 1,000,00(
l
X COMMERCIAL GENERAL LIABILITY
DAMAGE TO RENTS❑
S 50 0
i
CLAIMS MADE a OCCUR
M£D EXP (Any one person)
S 5,00
PERSONAL 4 ApV INJURY
$ 1,000,00(
A
Ij(
GENERAL AGGREGATE
$ 2 , p00 , 00
GEN'L AGGREGATE LIMIT APPLIES PER
PRODUCTS' COMPIOP AGG
S 1, 000, 00
X POLICY PRO-
JECT LOC
AUTOMOBILE
LIABILITY
ANY AUTO
COMBINED SINGLE LIMIT
+Fa accident)
-
$
BODILY INJURY
[Perparaor)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY
(Per accident)
$
HIRED AUTO$
NONOWNED AUTOS
'
PROPERTY DAMAGE
(Per dGddGntJ
S
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
S
OTHER THAN EAACC
$
ANYAUTO
S
AUTO ONLY AGG
EXCESSIUMBRELLALIABILITY
EACH OCCURRENCE
$
OCCUR ❑ CLAIMS MADE
AGGREGATE
S
$
$
DEDUCTIBLE
$
F�ETF_NTION $
B
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETORIPARTNERIEXECUTiVE
OFFICEEMBEf✓• £XCLU IZ'MDED?
406414S
01/01/2009
01/01/2010
X wC STA IT O P
E.L. EACH ACCIDENT
$ 1,00U,000
E.L. DISEASE - EA EMPLOYEE
S 1,000,000
If ycs, d¢sc ibe urder
SPECIAL PROVISIONS below
E.L. DISEASE. -POLICY LIMIT I
S 110001000
OTHER
DESCRIPTION OF OPERATIONS I I-OCATIONS f VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
e certificate holder is named as an Additional Insured with respect to the ongoing operations
f the Named insured on the General Liability only.
City of Fort Collins
Finance & Purchasing Department
Attn: Christine Jarvis
215 N. Mason St., Second Floor
PO Box 580
Fort Collins, CO 90522-0580
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES SE 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; 14AGENTS OR REPRESENTATIVES,
AUTHORIZED REPRESENTATIVE r� P ° ;� ar° J �,y✓�C ,,,�,
Leslie Shade
`b/HVVRU 41Vn1W--.- .'00
COLORADO—BW INSURANCE Fax 19702672231 Jul 20 2009 04:50m P002/002
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 (2001/0a)