HomeMy WebLinkAbout129302 HAGEMAN EARTH CYCLE - INSURANCE CERTIFICATE (6)ACORDTM CERTIFICATE OF LIABILITY INSURANCE
DATE (I
0/27/2o09,,27,2
PRODUCER
PINNACOL ASSURANCE
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY
7501 E Lowry Blvd
Denver, CO 80230-7006 f = I I no �L�
AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
NOV - 5 2009
INSURERS AFFORDING COVERAGE _ NAIC#
INSURED '—�
INSURER A: PINNACOL ASSURANCE
41190
HAGEMAN EARTHCYCLE INCH
3501 E PROSPECT
FORT COLLINS, CO 80525
INSURER e:
INSURERD.
INSURER D.
INSURER E
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDNG
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMMENT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
ADD'L
I
I
POLICYEFFECTIVE
POLICY EXPIRATION
LTR
INSRD
TYPE OF INSURANCE
POLICY NUMBER
DATE(MWDD/YYYY)
DATE(MM/DD/YYYY)
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
DAMAGE TO RENTED
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE 11 OCCUR
PREMISES
MED EXP(Any one person)
PERSONAL &ADV INJURY
-
GENT AGGREGATE LIMIT APPLIERS PER.
GENERAL AGGREGATE
PRODUCTS - COMP/OP AGG
POLICY PROJECT LOC
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
ANY AUTO
(Ea Accident)
BODILY INJURY
ALL OWNED AUTOS
SCHEDULED AUTOS
(Per person)
BODILY INJURY
HIRED AUTOS
NON -OWNED AUTOS
(Per accident)
PROPERTY DAMAGE
(Per accident)
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
OTHER THAN EA ACC
ANY AUTO
AUTO ONLY. AG
EXCESS/UMBRELLA LIABILITY
EACH OCCURRENCE
AGGREGATE
OCCUR 171 CLAIMS MADE
DEDUCTIBLE
RETENTION $
WORKERS COMPENSATION AND
X WC STATU. OTHER
A
EMPLOYER'S LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
4036218
10/01/2009
10/01/2010
TOEA LIMITS
E.L EACH ACCIDENT
$100,000
_
OFFICER/MEMBER EXCLUDED?
E.L DISEASE- EA EMPLOYEE
$100,000
If yes, please describe under SPECIAL PROVISIONS below
E.L DISEASE- POLICY LIMIT
$500,000
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/EXCLUSIONS ADDE64Y ENDORSEMENTISPECIAL PROVISIONS
CERTIFICATE HOLDER
CANCELLATION
1191298
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
CITY OF FORT COLLINS
THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
ATTN: PURCHASING
MAIL 0 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
P O BOX 580
Fort Collins CO 80524
LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
Victoria Palmer
ACORD 25(2001/08)
Underwriter ACORD CORPORATION 1988
CERTIFICATE HOLDER COPY
CITY OF FORT COLLINS
ATTN: PURCHASING
P O BOX 580
Fort Collins CO 80524
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.
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