HomeMy WebLinkAbout129302 HAGEMAN EARTH CYCLE - INSURANCE CERTIFICATE (8)Client#: 24703
HAGEA
ACORDTM CERTIFICATE OF LIABILITY INSURANCE
DATE(MWDD/YYYY)
10/01 /2010
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.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. 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).
PRODUCER
Flood & Peterson Ins., Inc.
Corporate Mailing Address:
CONTACT
NAME:
PHONE FAX
(A/C. No.Ell: 970 356-0123 A/C, No : 9705066836
IL
ADDRESS: Kelly.Beauvais@fpinsurance.com
P. O. Box 578
Greeley, CO 80632
CUSTOMER ID #:
INSURER(S) AFFORDING COVERAGE
NAIC If
INSURED
Hageman Earth Cycle, Inc.
3501 E. Prospect Road
Fort Collins, CO 80525
INSURER A: Continental Western Group
INSURER B Pinnacol Assurance
INSURERC:
INSURER D :
INSURER E :
INSURER F :
COVERAGES CERTIFICATE NUMBER: REVISION -NUMBER:
THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LT R
TYPE OF INSURANCE
DDL
U
POLICY NUMBER
MWDDNYYV
EXP
MM/DD/YVYY
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE a OCCUR
X PD Ded:500
CWP234489328
12/01/2009
12/01/2010
EACH OCCURRENCE
$1 000,000
DAMAGE TO RENTED
PREMISES Ea occurrence
$100,000
MED EXP (Any one person)
$5,000
PERSONAL & ADV INJURY
$1,000,000
GENERAL AGGREGATE
$2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY 7 PRO LOC
PRODUCTS - COMP/OP AGG
$2,000,000
$
A
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
CWP234489328
12/01/2009
12/01/201C
COMBINED SINGLE LIMIT
(Ea accident)
$1,000,000
X
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
X
X
$
$
A
UMBRELLA LIAB
EXCESS LIAR
OCCUR
CLAIMS -MADE
CU236140828
12/01/2009
-
12/01/201
EACH OCCURRENCE
$1 00O 000
[�X
AGGREGATE
$1 000 000
DEDUCTIBLE
RETENTION 10000
$
X
$
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY V / N
ANY PROPRIETOR/PARTNER/EXECUTIVE❑
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
WA
4036218
10/01/2010
10/01/2011
X WC STATU- OTH-
E.L. EACH ACCIDENT
$100,000
E.L. DISEASE - EA EMPLOYEE
$100,000
E.L. DISEASE - POLICY LIMIT 1
$500OOO
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
Non -
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS.
Risk Management Dept.
Attn: Darlene AUTHORIZED REPRESENTATIVE
P.O. Box 580 _
01988-2009 ACORD CORPORATION. All rights reserved.
ACORD 25 (2009/09) 1 of 1 The ACORD name and logo are registered marks of ACORD
#S565954/M565947 KL.B