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HomeMy WebLinkAbout111375 COLORADO LIEN CO - INSURANCE CERTIFICATE,4co CERTIFICATE OF LIABILITY INSURANCE DADD/ 12/28/2s/2009 PRODUCER (605) 342-5555 FAX: (605) 3,42-7901 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Black Hills Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 820 St. Joseph ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. PO Box 3330 JAN 13 201 Rapid City SD 57709 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Regent Insurance Company Colorado Lien Company, A Division` of--- INSURER B: General Casualty of Wisconsin Pete Lien & Sons, Inc. ,JAN 7 20111 INSURERC: P 0 BOX 440 - INSURER D: Rapid City SD 57709 INSURERE: COVERAGES -" THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTAN DING 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 LIS ADD'` TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DAT D POLICY EXPIRATION ATE (MM/DDfYYYY1 LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS MADE � OCCUR CCI0219875 1/1/2010 1/1/2011 DAMAGE TO RETED PREM SES (Ea occur ence $ 300,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 11000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY X PRO X7 L 0 C AUTOMOBILE LIABILITY ANY AUTO _ COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X 1 BODILY INJURY (Per person) $ B ALL OWNED AUTOS SCHEDULED AUTOS 'CBAD219675 1/1/2010 1/1/2011 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 $ 10,000,000 X OCCUR 7 CLAIMS MADE AGGREGATE $ 10, 000, 000 $ A DEDUCTIBLE CCU0219875 1/1/2010 1/1/2011 $ X RETENTION $ 10,000 A - WCRKERS COMPENSATION- AND EMPLOYERS' LIABILITY Y / N X WC STATU- I I H-1 TQRY IJMITSJ�ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICEWMEMBER EXCLUDED? (Mandatory in NH) CPICO219875 1/1/2010 1/1/2011 E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYEE$ 100,000 If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT 1 $ 500,000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS "This certificate of insurance does not affirmatively or negatively amend, extend, or alter the coverage afforded by the insurance policy." City of Fort Collins is included as additional insured as required by contract. "This certificate of insurance does not affirmatively or negatively amend, extend, or alter the coverage afforded by the insurance policy." GtK I IhIGA I t HULUtK GANGI:LLATIQN (970) 221-6586 XFAX SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of Fort Collins DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN Attn : Matt NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL PO Box 580 Fort Collins,, CO 80522 -0580 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR AUTHORIZED REPRESENTATIVE M Maguire/MARILY ACORD 25 (2009/01) ©1988-2009 ACORD CORPORATION. All rights reserved. INS025 (200901) The ACORD name and logo are registered marks of ACORD