HomeMy WebLinkAboutDANCZAK RESOURCES INC - INSURANCE CERTIFICATEClient#: 41364 DANRE
ACORD- CERTIFICATE OF LIABILITY INSURANCE
DATE (MMID
07/14/2010YYY)
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Flood & Peterson Ins., Inc.
Corporate Mailing Address:
P 9
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P. O. Box 578
Greeley, CO 80632
INSURERS AFFORDING COVERAGE
NAIC #
INSURED
Danczak Resources, Inc.
P.O. Box 339
Johnstown, CO 80534
INSURER A: United Fire & Cas.
INSURER B: Pinnacol Assurance
INSURER C:
INSURER D:
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.
LTR
INSR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
POLICY EXPIRATION —DATE (MM/DDVM
LIMITS
A
GENERAL LIABILITY
60080110
07/18/10
07/18/11
EACH OCCURRENCE
$1 000 000
X COMMERCIAL GENERAL LIABILITY
DAMAGE TO RENTED nce
$1 OO OOO
CLAIMS MADE a OCCUR
MED EXP (Any one person)
$5 000
PERSONAL & ADV INJURY
$1 000 000
X PC Ded:250
GENERAL AGGREGATE
s2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
s2,000,000
POUCY PRO- LOC
A
AUTOMOBILE LIABILITY
ANY AUTO
60080110
07/18/10
07/18/11
COMBINED SINGLE LIMIT
(Ea accident)
$1 000
, ,000
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
X SCHEDULED AUTOS
BODILY INJURY -
(Per accident)
$
X HIRED AUTOS
X NON OWNED AUTOS
PROPERTY DAMAGE
(Per accident) -
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
$
AUTO ONLY: AGG
EXCESS/UMBRELLA LIABILITY
EACH OCCURRENCE
$
_
AGGREGATE
$
OCCUR CLAIMS MADE
$
DEDUCTIBLE
$
RETENTION $
B
WORKERS COMPENSATION AND
4099105
01/01/10
01/01/11
X weI
LIMITS CER
m'
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
E.L. EACH ACCIDENT
$100000
E.L. DISEASE - EA EMPLOYEEI
$100000
OFFICER/MEMBER EXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE -POLICY LIMIT
1 $500000
OTHER
DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES/ EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS
Re: Snow Removal - Attn: John Stevens
City of Fort Collins, its officers, agents and employees are named as
additional insured, but only as respectsliability arising out of ongoing
operations of the named insured (Excluding Workers' Compensation).
Wnq RI I I a V71111 _111.191-199:1
City of Fort Collins
P O Box 580
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 An DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
AUTHORIZED REPRESENTATIVE
F76o01L �4++�1sOa�J ,�Nt✓r a.�JG1t a T^JC.
ACORD 25 (2001/08) 1 of 2 #S543837/M543835 PXP 0 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 25-S (2001108) 2 of 2 #S543837/M543835