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HomeMy WebLinkAbout457049 AAA PEST PROS - INSURANCE CERTIFICATE (2)&CORD. CERTIFICATE OF LIABILITY INSURANCE 04/02/10 PRODUCER OD08408 1-415-541-7900 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Wells Fargo Insurance Services USA, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 45 Fremont Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Suite 800 San Francisco, CA 94105 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: American Safety Indemnity Company AAA Pest Pros James Marrquardt INSURERB: PO Box 20235 INSURER C: Boulder, CO 80308 INSURERD: INSURER E: CAVFROGFS 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 LTR DD' NSR POLICY NUMBER POLICYEFFECTIVE DATE MM/DD POLICY EXPIRATION DATE MM/DD LIMITS A GENERAL LIABILITY TPG20063507 03/24/10 03/24/11 EACH OCCURRENCE $1,000,000 MERCIALGENERALLIABILITY DAMAGE TO RENTEU-- PREMISESEaoccurence $100,000 17CLAIMSMADE Fx-1 OCCUR MED EXP (Any one person) $ 5 , 000 PERSONAL &ADV INJURY $ 1,000,000 GENERAL AGGREGATE $1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OPAGG $1,000-,000 X: POLICY PRO- LOC AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULEDAUTOS BODILY INJURY (Peraocident) $ HIRED AUTOS NON-OWNEDAUTOS PROPERTYDAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY -EA ACCIDENT $ OTHERTHAN EAACC $ ANYAUTO $ AUTOONLY: AGG EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ AGGREGATE $ OCCUR CLAIMSMADE $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND WC STATU- OTH- RYLIMI R EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ OFFICER/MEMBEREXCLUDED? If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Certificate holder is included as additional insured per blanket policy endorsement. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of Fort Collins DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Attn: Purchasing Division IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR P.O. Box 580 REPRESENTATIVES. Fort Collins, CO 80522 AUTHORIZED REPRESENTATIVE USA ACORD 25 (2001/08) Jmanangquil ©ACORD CORPORATION 1988 15125474 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. ALUM) 20 (l IMB) 3:4 COMMERCIAL GENERAL LIABILITY CG 20 33 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. orallwAve This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section 11 - Who Is An Insured is amended to include, as -an additional insured any person I or or- ganization ' for Whom you are performing opera- ti6ns When you and such person or organization :have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on yourpolicy. Such person or organi za6ti on is an additional inslu,red.only with re- ,spect to liability for "bodily injury", "properly dam- age" or —persona! and advertising injury " caused, in wh6le,or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those.acting on your, behalf; B. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions:apply: This -,insurance dobs, not apply to. 1. "Bodily injury', "property damage" or "personal and advertising injury" arising out of the ren- dering of, or the failure to.render, any,profes- sional architectural, engineering or surveying services; including: in the performance of your ongoing operations for the additional insured. A person',s-or organ I ization.'s status as an qddi 2. tional insured under this endorsement" ends -when - your operations ions for that additional insured are completed. a. The preparing, approving, or failing 'to prepare. or approve, maps, shop drawings, opinions, reporIs, surveys, 'field orders, change orders .or drawings and specifica7 tions; or b. Supervisory, inspection, architectural or engineering activities. ."Bodily injury" or "property damage" occurring After: 6. All Work, -including materials, parts or equipment furnished in connection with :such work, on the project (other than - ser- Vice, maintenance or repairs) to be per- formed by or- on behalf of the additional in- sured(s) at the location of the covered operations has been completed; or b. That portion of "your work" out of which the injuryor damage arises has been put to its intended use se by any person or organization other than another contractor or subcon- .tractor engaged in performing operations for a principal as a part of the saute project. C.G 20 33 07 04 � I I SO Properties, Inc.i 2004 Page 1 of 1 F/4RM' BUREau. l� Evidence of Insurance Additional Interest Interest 90205984 CITY OF FORT COLLINS PO BOX 580 FT COLLINS, CO 80524 Policy Number CS205984-13 Amended Date 05/13/2010 Named Insured VAN O BREWSTER PEGGY L BREWSTER 2132 N CR #25E BELLVUE, CO 80512 Effective Date 05/13/2010 Expiration Date 05/13/2011 This form is not the contract of insurance. It is a memorandum of coverage limited to the interest and applicable to the item below. Risk# I Coverage 2 1 Combined Single Limit 2 1 Medical Payments To Others 2 1 Fire Legal Liability (Farm Structures) Limits of Liability Each Person Each Occurrence NC* 500,000 5,000 NC* 50,000 25,000 Legal Location 680 ACRES AT TWSP 10 RNG 63 ELBERT, CO 100 ACRES AT TWSP 6 RNG 81 JACKSON,CO 80 ACRES AT TWSP 6 RNG 81 JACKSON,CO 160 ACRES AT TWSP 6 RNG 81 JACKSON,CO 80 ACRES AT TWSP 6 RNG 81 JACKSON,CO 80 ACRES AT TWSP 7 RNG 80 JACKSON,CO 400 ACRES AT TWSP 008 RNG 070 LARIMER, CO 150 ACRES AT TWSP 008 RNG 070 LARIMER, CO 100 ACRES AT TWSP 008 RNG 070 LARIMER, CO 150 ACRES AT TWSP 008 RNG 070 LARIMER, CO 200 ACRES AT TWSP 008 RNG 070 LARIMER, CO 400 ACRES AT TWSP 007 RNG 070 LARIMER, CO 400 ACRES AT TWSP 008 RNG 070 LARIMER, CO 150 ACRES AT TWSP 008 RNG 070 LARIMER, CO 100 ACRES AT TWSP 008 RNG 070 LARIMER, CO 150 ACRES AT TWSP 008 RNG 070 LARIMER, CO 200 ACRES AT TWSP 008 RNG 070 4423716 Colorado Farm Bureau Mutual Insurance Company Pg. 1 9177 E. Mineral Circle, Centennial, CO 80112 UREAU '.FARM B II�tSURAl�CE Risk# Coverage Limits of Liability Legal Location Each Person Each Occurrence LARIMER, CO 400 ACRES AT TWSP 007 RNG 070 LARIMER, CO 400 ACRES AT TWSP 007 RNG 070 LARIMER, CO 400 ACRES AT TWSP 008 RNG 070 LARIMER, CO 150 ACRES AT TWSP 008 RNG 070 LARIMER, CO 100 ACRES AT TWSP 008 RNG 070 LARIMER, CO 150 ACRES AT TWSP 008 RNG 070 LARIMER, CO 200 ACRES AT TWSP 008 RNG 070 LARIMER, CO 100 ACRES AT TWSP 07 RNG 67 WELD, CO 100 ACRES AT TWSP 07 RNG 67 WELD, CO 100 ACRES AT TWSP 07 RNG 67 WELD, CO Your interest in risk(s) 2 is as a Additional Insured. Coverage is restricted to this relationship. Agent's Name JIM MILLER Agent's Address 335 E MOUNTAIN FT COLLINS, CO 80524 Agent's Phone # (970) 482-3952 Date 04/01 /2010 4423716 Colorado Farm Bureau Mutual Insurance Company Pg. 2 9177 E. Mineral Circle, Centennial, CO 80112 INTERLINE WI 00 98 07 06 DATE: 04/07/2010 WILSHIRE INSURANCE COMPANY P.O. Box 7006, Lancaster, California 93539-7006 NOTICE OF REINSTATEMENT To ALL Insureds, Loss Payees, and Other Interests, if any, named in the Policy described below: Additional Interest FORT COLLINS, CITY OF DIRECTOR OF PURCHASING 215 N MASON, 2ND FLR FORT COLLINS, CO 80522-0000 Policy Number: BA2494623 57 02 We are notifying you that the policy shown below is reinstated effective at 12:01 a.m. Standard time at the First Named Insured's mailing address on the date shown below. This Notice of Reinstatement does not vary, waive, alter or extend any of the Terms, Conditions, Agreements or Declarations of the policy other than herein stated. DATE OF CANCELLATION REINSTATEMENT EFFECTIVE 05/01 /2010 05/01 /2010 Countersigned at Lancaster, California on 04/07/10 ab_� • Authorized Representative Policy Issued through, Agency: TRUCKWRITERS. OF COLORADO INC 1510 GLEN AYR DR STE 6 LAKEWOOD, CO 80215-3051 Named Insured: SAINTS TRUCKING, LLC 4502 HIBISCUS ST FORT COLLINS, CO 80526-0000 Countersignature Producer Code: 000300001 WI 00 98 07 06 Page 1 of 1 ADD'L INSURED 91 04/07/2010