HomeMy WebLinkAboutJORDANS TREE - INSURANCE CERTIFICATE�ly�J/A CERTIFICATE OF LIABILITY INSURANCE JORD
DDNYYY)
DATE (MMI10/10
-
02/
PRODUCERTHIS
CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Front Range Insurance Group
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
1100 Haxton Drive Suite 100
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Fort Collins CO 80525
Phone: 970-223-1804
INSURERS AFFORDING COVERAGE
NAIC #
INSURED
INSURER A: The Hartford
INSURER B: Pinnacol Assurance
Jordan's Tree
Moving & Maintenance, Inc.
INSURER
1025 Smithfield Drive
Fort Collins CO 80524
INSURER D:
i
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.
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LTR
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INSRC
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE (MWDDNM)
POLICY EXPIRATION
DATE (MWDDNM)
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
A
X
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE � OCCUR
34UUNSR3887
03/10/09
03/10/10
PREMISES(Eaoccurence)
$ 300,000
MED EXP (Any one person)
$ 10,000
PERSONAL &ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2 , 000 , 000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
$ 2,000,000
POLICY PEa LOC
A
X
AUTOMOBILE
LIABILITY
ANY AUTO
34UUNSR3887
03/10/09
03/10/10
COMBINED SINGLE LIMIT
(Ea accident)
$ 1,000 000
r
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 / N
ANY PROPRIETOR/PARTNER/EXECUTIVE ❑
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
4040726
03/01/09
03/01/10
X TORY LIMITS ER
E.L. EACH ACCIDENT
$ 1000000
E.L. DISEASE - EA EMPLOYEE
$ 1000000
If yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE- POLICY LIMIT
$ 1000000
OTHER
A
Equipment
34UUNSR3887
03/10/09
03/10/10
Leased Eq $250,000
Ded. $500
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
The City of Fort Collins, its officers, agents and employees are named as
additional insured with regards to general and auto Liability.
GERTIFIGATE MOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
CITY OF DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN
i 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
Puchasing Dept. REPRESENTATIVES.
PO Box 580 AUTHORIZED PRESENTATIVE _
Fort Collins CO 80522 1
ACORD 25 (2009/01)
The ACORD name and logo are registered marks of ACORD
reserved.
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
This Certificate of Insurance 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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