HomeMy WebLinkAboutWESTERN STATES LAND SERVICES - INSURANCE CERTIFICATE (3)Ro® CERTIFICATE OF LIABILITY INSURANCE OP ID Js DATE(MM/DD/YYYY)
PRODUCER
Richards, Seeley, & Schaefer,
Inc.
3640 W. 112th Avenue
Westminster CO 80031
Phone:303-429-3561 Fax:303-427-0611
INSURED
Western States Land Services
505 N Denver Avenue
Loveland CO 80537
COVERAGES
WESTE-1 11/25/09
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE NAIC #
INSURER A: American States Insurance
INSURER B: P'innac01 Assurance 41190
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.
LTR NSR TYPE OF INSURANCE POLICY NUMBER l)ATUE MMIDID POLICY
ATE MM/DDYYYY LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE X❑ OCCUR
0 2 BP 8 5 6 7 0 910
12 / 15 / 0 9
12 / 15 / 10
AMA _EA
PREMISES (Ea occurence)
$ 250,000
MED EXP (Any one person)
$ 10,000
PERSONAL & ADV INJURY
$ 11000,000
GENERAL AGGREGATE
$ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
$ 11000,000
POLICY RO
PCT LOC
JE
A
AUTOMOBILE
LIABILITY
ANY AUTO
02CD15012460
01/30/10
01/30/11
COMBINED SINGLE LIMIT
(Ea accident)
g 1, 000, 000
X
BODILY INJURY
(Per person)
ALL OWNED AUTOS
SCHEDULED AUTOS
$
X
BODILY INJURY
(Per accident)
HIRED AUTOS
NON -OWNED AUTOS
$
X
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
$
AUTO ONLY: AGG
EXCESS / UMBRELLA LIABILITY
EACH OCCURRENCE
$
OCCUR CLAIMS MADE
AGGREGATE
$
$
DEDUCTIBLE
$
RETENTION $
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y I N
ANY PROPRIETOR/PARTNER/EXECUTIVE--7
OFFICER/MEMBER EXCLUDED? u
1803222
01 / 01 / 10
01 / 01 / 11
X TORY LIMITS ER
E.L. EACH ACCIDENT
$ 10 0 , 0 0 0
E.L. DISEASE - EA EMPLOYEE
$ 10 0 , 0 0 0
(Mandatory In NH)
If yes, describe under
E.L. DISEASE - POLICY LIMIT
$ 5 0 0 , 0 0 0
SPECIAL PROVISIONS below
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
City of Ft Collins are included as additional insureds.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIOI
CITY019 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 Ft. Collins IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
Mr O'Neil
PO BOX 58O REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
Ft. Collins CO 80522-0580
ACORD 25 (2009/01) WiFreserved.
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