Loading...
HomeMy WebLinkAbout124948 TOP GUN PRESSURE WASHING INC - INSURANCE CERTIFICATE (8)doF CERTIFICATE OF LIABILITY INSURANCE OP ID TP PATE(MJE�!-FDM/ 8// 11/1 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. 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 Brown & Brown Inc 125 ' S Howes , 5th Floor NAME: PHONE FAX Alc, No, Ext : (A/C, No): ADDRESS: - P O BOX 2226 CUSTOMER ERID#: TOPGU-1 Fort Collins CO 80522-2226 Phone:970-482-7747 Fax:970-484-4165 INSURER(S) AFFORDING COVERAGE NAIC# INSURED INSURERA: Pinnacol Assurance Company 41190 Top Gun Pressure Washing Inc. 50D W 67th St INSURER B: Mountain states Indemnity Co. 10177 INSURERC: Mountain States Mutual 14648 Loveland CO 80538 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. LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM/DD/YYYY) (MMI/DDDIYYYY) LIMITS B GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑X OCCUR X Bklt Waiver CPI011641104 10/31/10 10/31/11 EACH OCCURRENCE $ 1 , 000 , 000 PREMISEGES (E oNccu ence) $ 100 , 000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $1,000,000 X GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PRO LOC JECT PRODUCTS - COMP/OP AGG s2,000,000 $ B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS Bklt Add Il Insd BAI011641104 10/31/10 10/31/11 COMBINED SINGLE LIMIT $ 1,000,000 X BODILY INJURY BODILURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ rXI $ C X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE UMB011641104 10/31/10 10/31/11 EACH OCCURRENCE $ 5000000 AGGREGATE $ 5000000 DEDUCTIBLE RETENTION $ 10000 $ x $ IA -WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY OFFICER/MEMBER EXCLUDED PRCPRIETOR/PARTNERJEXECUTIVT (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N I A 4Us1609 07/01/10 07/01/11 X WCSTATU- OTH- TORY LIMITS ER - E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE $ 1,000,000 E.L. DISEASE -POLICY LIMIT $ 1 , 000, 000 A A Leased or Rented Contractor Eg CPI011641104 CPI011641104 10/31/10 10/31/10 10/31/11 10/31/11 Lsd/Rnted 100,000 Cntr Eg 137.160 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) The City, its officers agents and employees shall be named as additional insureds on the General & Auto Liability CERTIFICATE HOLDER CANCELLATION City of Fort Collins John Stevens Purchasing Department PO Box 580 Fort Collins CO 80522 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE FTCPURC I THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. REPRESENTATIVE Tyler.B. Allen ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD A OK� CERTIFICATE OF LIABILITY INSURANCE oP ID LD DATE6/22/11 06 22 11 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 NAME: Blown & Brown Inc 4532--Boardwalk Dr, Suite 200 PHONE (A/C, NO Ezq: (AIC, No): _ ADDRESS: Fort Collins CO 80525 PRODUCER CUSTOMER ID p: TOPGU-1 Phone:970-482-7747 Fax:970-484-4165 INSURER(S) AFFORDING COVERAGE NAIC it INSURED INSURER A: Pinnacol Assurance Company 41190 TotGun Pressure Washing Inc. 50W 67th St INSURER B: mountain states Indemnity Co. 10177 INSURER C: Mountain States Mutual 14648 Loveland CO 80538 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 REOUIREMENT, 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. LTR"Ki TYPE OF INSURANCE INSR WVD POLICY NUMBER POLICY EFFT (MMIDD/YYYY) (MMIDDIYYYY) LIMITS $ GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 51 OCCUR X Bklt Waiver CPI011641104 _ 10/31/30 10/31/11 EACH OCCURRENCE $ 1,000,000 P'MA EMISES(Ea occurrence) $100,000 MED EXP(Any one person) $ 10,000 PERSONAL B ADV INJURY $ 1,000,000 % Blkt Addl Insd GENERAL AGGREGATE s2,000,000 GEN-L AGGREGATE LIMIT APPLIES PER: POLICY FX7 IRO- F7 ECT LOC PRODUCTS - COMPIOP AGG $2,000,000 $ B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS Bklt Add'1 Insd BA1011641104 10/31/10 10/31/11 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per cc debt) $ PROPERTY DAMAGE (Per accident) $ $ X $ C X UMBRELLA LIAB EXCESS LIAR X OCCUR CLAIMS -MADE UMB011641104 10/31/10 10/31/11 EACH OCCURRENCE $ 5000000 AGGREGATE $5000000 HDEDUCTIBLE $ RETENTION $ 10000 $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETOR/PARTNERIEXECUTIV�IyI OFFICER/MEMBER EXCLUDED? a (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below /A 031609 BLANKET Wos 07/01/11 07/01/12 X A�—�T ' TORY LIMITS ER EL EACH ACCIDENT $1, 000, 000 E.L. DISEASE - EA EMPLOYEE $ 1, 0 0 0 , 0 0 0 E. L. DISEASE -POLICY LIMIT 1 $1, 000, 000 A A Leased or Rented Contractor E CP1011641104 CPI011641104 10/31/10 10/31/10 1o/31/u 10/31/11 Lad/Anted 100,000 Cntr E 137,160 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Anach ACORD 101, AddlUonal Remarks Schedule, If more space is soulretl The City, its officers agents and gmplcyyees shall be named as aZditional insureds on the Generai & Auto Liability CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE FTCPURC I THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Fort Collins John Stevens Purchasing Department PO Box 580 ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD