HomeMy WebLinkAbout108976 L AND M ENTERPRISES, INC. - INSURANCE CERTIFICATEACDRQ CERTIFICATE OF LIABILITY INSURANCE
iz/18/20 9)
PRODUCER (970)679-7333 FAX (866)456-4265
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Ewing -Leavitt Insurance Agency
4025 St. Cloud Dr.
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Suite 100
' 0^' _ ..
Loveland, CO 80538 renee-stein@leavitt.com
INSURERS AFFORDING COVERAGE--._ _..__.� _:.:�.: `.....NAIC_#._..__
___.._..
INSURED .'L.&. M- Enterprises.,,..Inc.. _._.-.....-_. _..____ .:..
.INSURERA: Secura-Insuraheii"---• ... •-•• --;.
-_ __..................___
P. 0 ,BOX_.W-
INSURER B: p A-
`735 East Highway 56 ; ;
INSURERC: . ._....... .._._...._..._._...-__-..-_.__.
.. ___ .___....__.
' B6r,tHoud;"'CO' 80513
INSURERD:
INSURER E:
CnVFPAnFR
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
ADDT
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DM
POLICY EXPIRATION
DATE(MM/DDNY)
LIMITS
GENERAL LIABILITY
CP3155200
01/01/2010
01/01/2011
EACH OCCURRENCE
$ 1,000,000
X COMMERCIAL GENERAL LIABILITY
DAMAGE TO RENTED
$ 100,000
CLAIMS MADE a OCCUR
PIED EXP (Any one person)
$ 10,000
A
X Bl kt Addl Insureds
PERSONAL & ADV INJURY
$ 1,000,000
X
Bl kt Wvr Subrogatn
GENERAL AGGREGATE
$ 2,000,000
GENT AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
$ 2,000,000
POLICY X PRO- LOC
JECT
AUTOMOBILE
LIABILITY
ANY AUTO
A3155201
01/01/2010
01/01/2011
COMBINED SINGLE LIMIT
(Ea accident)
$
1,000,000
X
BODILY INJURY
(Per person)
$
.A
ALL OWNED AUTOS
SCHEDULED,AUTOS
HIRED AUTOS
....,,.. .. ..,.._.:.
NON'OWNED AUTOS '
..
�
-
_,
_._ -.. .__...
_
X
-BODILY INJURY --
(Per accident) ,
-
$ !
X "
..... ._..
''
_..._.. _... .__..._.. --
. _._. ...
� PROPERTY DAMAGE _ ......
(Per accident).___..___....._._-_
._. r'-- ._ ..
$
...._._._.......-__—...,_.__'_.___,.
....
AUTO ONLY-- EA ACCIDENT--
OTHERTHAN EA ACC
$
ANY AUTO
$ -'
AUTO ONLY: AGG
EXCESS/UMBRELLA LIABILITY
CU315 5202
01/01/2010
01/01/2011
-EACH OCCURRENCE
$ 8,000,000
X OCCUR CLAIMS MADE
AGGREGATE
$ 8,000,000
A
$
$
DEDUCTIBLE
X RETENTION $ 10 , 0O
$
WORKERS COMPENSATION AND
WC315 7481
-
X WC "RySTATU- OTHER
A
EMPLOYERS' LIABILITY
ANY-?ROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
BLANKET WAIVER OF
SUBROGATION INCLUDED
01/01/2010
01/01/2011
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
A
OTHER
ontractors' Equipment
CP3155200
01/01/2010
01/01/2011
Leased/Rented Equipment
$150,000 limit/$1,000 ded
$85,000 Installation Floater
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
e: 7005 East Prospect Road Landscaping Improvements - City of Fort Collins, Engineer,
heir respective officers and employees are named additional insured as respects work performed.
City of Fort Collins
Financial Services
Purchasing Division
215 N. Mason St. 2nd Floor
Fort Collins, CO 80522
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE 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, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
Renee Stein/RESTEI I \Jkilo—�
ACORD 25 (2001/08) @ACORD CORPORATION 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.
ACORD 26 (2001/08)