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HomeMy WebLinkAbout126682 A & M LANDSCAPE INC - INSURANCE CERTIFICATE (4)ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID ,JL DATE(MM/DD/YYYY)
A&MLA-1 1 08/12/10
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIO
Six & Geving Insurance Inc #4 ONLY AND CONFERS NO.RIGHTS UPON -THE CERTIFICATE
Denver Branch HOLDER. THIS CERTIFICATE DOES -NOT -AMEND, EXTEND -OR
225 Union "Blvd. #575ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW
Lakewood CO 80228-
Phone: 720-962.-0930 Fax:720-962-0942 INSURERS'AFFORDING COVERAGE NAIC #
INSURED INSURER A: Plnnacol Assurance _-. _ 41190_- ._.
... _ _..: INSURER B:
A & M"Landscape Concepts, Inc.
Allen- Winter wsuRER c:
749 S . Lemay Avenue PMB 221 INSURER D:
Fort Collins CO 805�4
- INSURER E:
LK91VJ a:r_lC1 �-1
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
YNSR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE MM/DD/YY
POLICY EXPIRATION
DATE MM/DD/YY
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE 0OCCUR
- _
PREMISESSO a ocNcurence$
MED EXP (Any one person)
$
PERSONAL & ADV INJURY
$
GENERAL AGGREGATE
$
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
$
POLICY n PRO- LOC
JECT
AUTOMOBILE
LIABILITY
ANY AUTO .. . _
. • .. -. _
COMBINED SINGLE LIMIT
(Ea accident)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
'
. - _
-
BODILY INJURY- --
(Per person)
$ -- - - -
BODILY INJURY - -
(Per accident)
- $--- — - - -
-
HIRED AUTOS
'NON -OWNED AUTOS _
.,.
.PROPERTY .DAMAGE, _..
..(Per accident)
_
'..
...- - -•
-
GARAGE LIABILITY
I
'AUTO ONLY - EA ACCIDENT
$
F I ANY AUTO
.
OTHER THAN EA ACC
_
$
$
-
-
AUTO ONLY: AGG
EXCESS/UMBRELLA LIABILITY
EACH OCCURRENCE
$
OCCUR ❑ CLAIMS MADE
AGGREGATE `
$
$
DEDUCTIBLE
$
$
RETENTION $
-
-
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
4115033
0S/01/10
09/01/11
X TORY LIMITS X ER
EACH ACCIDENT
/� /�
$ 500000
OFFICER/MEMBER EXCLUDED?
If yes, describe under
E.L. DISEASE- EA EMPLOYE
$ 500000
E.L. DISEASE -POLICY LIMIT
-$ 500000
SPECIAL PROVISIONS below
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
RE: All Projects/All Locations
%,r-R i irm A i c nULUMM UANUELLATION
CTYFT-1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN
City of Fort Collins NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
Purchasing Or Risk Mgmt P.O. Box 580 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
Fort Collins CO 80522 REPRESENTATIVES.
AUTHOD RE_ (/l PRESENT�7VE
ACORD 25 (2001/08) © ACORD CORPORATION 1
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 (2001/08)
JUN.07.2010 21:56 '3702060301 Mountain Plains Agency a,7592 P.001 /001
.R� CERTIFICATE OF LIABILITY INSURANCE OP10 CL rDATE(MM/DDIYYYY)
06 08 10
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMP ANT: I the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROtFATION 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).
PRODUCER
NAME:
PHONE -._.. ...--'-
Mountain Plains Agency LLC (AIC, No, Ext): �SArc, No):
E-MAIL
4532 McMurry Avenue, Suite 150 ADDRESS: _
Fort Collins CO 80525 PRODUCER A&I�II,A-1
CUSTOMER ID /f:
_.__.... ........_.-T
.B one: - -OSOO FaX:970-206-0801 1NSURER(S)AFFORDING COVERAGE NAICN
INSURED INSURERA: Navigator Insuance
&M Landscape Concepts, Inc. INSURERS:
Alan Winter
749 S Lemay, Unit 3 INSURERC:
Fort Collins CO 80524 --
INSURER _b :
INSURER E I I
_.... INSURER F :
COVERAGES CERTIFICATE NUMBER: GPv14InM Mllnnot:a.
THIS IS To CF.k I U-Y THAT THE POLICIES OF INSURANCE LIS I ED BELOW HAVE BEEN ISSUED TO THE uaSUKEO NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTW ITI ISTANDING ANY KLQUIREMENT, TERM OR CONDITION GF ANY CONTRACT OR OTHER DOCUMENT WITH RF..SPFCT To WHICH I HIS
CERTIFICATE MAY BE ISSUFU OK MAY PERTAIN, THE INSURANCE AFPORDFI.) uY THE I.OUCIES DESCRIBED I.I£REIN IS SLIBJF.Cf I O AI
I 1 HE TERMS.
EXCLUSIONS AN]) CONDITIONS OF SUCH POLK:IES. L1MI f,, SHOWN MAY HAVE DCEN REDUCED BY PAID CI AIMS
TADO LTR TYPE OF INSURANCE I R VJVD POLICY NUMBER MM106Y POLICY EXP
(MMIbC Yrvv)
' `--
LIMITS
GENERAL UA81LITY
EACI I OCCURRENCE
I $ 1000000
A i X COMMERCIAL GENERAL LIABILIiv
TBD 05/27/10 105/27/11
`DAMAG-IG KENIt: D
PRtMISES(Feoccurence)
$ 50000
CLAIh1S-MAD£ i X OCCUR
! MHnFxP(Any one peraon)--_....5
1000
S 1000000
=� —.... .... X
i
I
' PERSONAL IsADV INJURY
$ 2 0 0 0 0 0 0
CEN ERAL AGGREGATE
GEN'L AGGREGaI'E LIMIT APPLIES PER
PRODUCTS - COMP/OP AGG 1s2000000
$ I PUI.ICY
JECT LOC
g
AUTOMOBILE LIABILITY
COMBINED SINC,LE LIMI'i
ANY AUTO
(Ca accident)
$
BOUII.Y INJLJHY ( 9 P r person)$
I AlI OWNEDAUTOS
SCHEDULED AUTOS
BODILY INJURY (Pei accident): S
�___...._._.._._.._.-
DAMAGF
HIRED AUTOS i
(Prr accident)
NUM -OWNED AUTOS
:5
UMBRELLA uAe
I � OCC:UH
.' EACH OCCUHHtNCr ! :$
EXCESS U..4 , CLAIM5_MADE!
aGCHI-GArF
01,:D IC ABLE
$
I RETENTION S
WORKERS COMPENSATION
AND EMPLOYERS' uasILITY Y I N i
IpHv 4.IMITS
j ANY PROPRIETOR/PARI'NFHIEXEUUTIV
I OFFICERIMF..MRFR 1-XCLUDED? NIA '
_
! E.L. EACH ACCIDENT -_�b-
(Mandatary In NH)
If yee, de s iibe under
L.L. DISEASE - EA CMPLOYEC
$
! DESCRIPTION OF OPERATIONS oalow
E.L. DISEASE - POLK)Y LIMIT
$
I
i
DESCRIPTION OF OPERATIONS I LOCATIONS! VEHICLES (Attach ACORD 101 Additional Remarke Schedule, if more apace is required)
City of Fort Collins is listed as additional insured.
—11--,-,bn1" nv611rc IN CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
FTCOLLl I THE EXPIRATION bATE'(HEREOF, NOTICE WILL BF oET IvEREO IN
ACCORDANCE WITH THE POLICY PROVISIONS,
City Of Fort; Collins AUTHORt1E0REPRESENTATIV
Purchasing & Risk Management
215 N Mason, Po Box 580 Candy Lopez
Fort Collins CO 80522
C� 1988.2009 AC RD CORP0 ION. All r g rase
ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD J