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HomeMy WebLinkAbout281678 HEIMBUCK DISPOSAL INC - INSURANCE CERTIFICATEOP ID: MM A�oRon CERTIFICATE OF LIABILITY INSURANCE DATE11/01D/YYYY) 1 1 /01 /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 970-674-8825 Renaissance Insurance Group 970-674-8826 P O Box 478 101 E Main Street Windsor, CO 80550 CONTACT NAME: PHONE FAX Ext : A/C,No E-MAIL ADDRESS: PRODUCER HEIMB-1CUSTOMER ID #: INSURERS) AFFORDING COVERAGE NAIC # INSURED Heimbuck Disposal, Inc. INSURERA:Allied Insurance Company Tim Heimbuck PO Box 270310 INSURER B : Fort Collins, CO 80527 INSURER C INSURER D : INSURER E : INSURER F : CnVFRAGFR 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. INSR LTR OF INSURANCE L ADDTYPE UB POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 7 OCCUR ACPGL07551662675 - 11/01/10 11/01/11 EACH OCCURRENCE $ 1,000,000 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: 17 POLICY PRO LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS ACPBA7551662675 17/01/10 11/01/11 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ X PROPERTY DAMAGE (Per accident) $ X X $ UMBRELLA LIAB7CLA EXCESS LIAB CCUR IMS-MADE N/A EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? ❑ (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A 4125234 08/01/10 08/01/11 WC STA rU- OTH- X TORY LIMITS I ER E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) CERTIFICATE HOLDER CANCELLATION FTCPURC 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. Purchasing Division AUTHORIZED REPRESENTATIVE Attn: Ed Bonnette P.O. Box 580 f� Fort Collins, CO 80525 ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD cJE�oRO® CERTIFICATE OF LIABILITY INSURANCE OP ID MIA DATE (MM/DD/YYYY) / 06/16/10 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 Renaissance Insurance Group-NAME: P O Box 478 PHONE A/C, No Ext : (A/C, No): ADDRESS: 101 E Main ,Street Windsor CO 80550 PRODER CUSTOMER ID #: HEIMB-1 Phone:970-674-8825 Fax:970-674-8826 INSURER(S) AFFORDING COVERAGE NAIC# INSURED INSURERA: Allied Insurance Company Heimbuck Disposal, Inc. Tim Heimbuck INSURERB: Pinnacol Assurance INSURER C PO BOX 270310 Fort Collins CO 80527 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) (MM/DD/YYYY) LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FXI OCCUR ACPMCT07531662675 11/01/0911/01/10 - EACH OCCURRENCE $ 1, 000, 000 PREMISES (Ea occurrence) $100,000 MED EXP (Any one person) s5,000 BADV INJURY $ 1, 000, OOO -PERSONAL GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY x PROJECT LOC PRODUCTS - COMP/OP AGG $ 2 , 0 0 0 , 0 0 0 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS ACPBA7531662675 11/01/09 11/01/10 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ X PROPERTY DAMAGE (Per accident) $ X X $ UMBRELLA LIAB EXCESS LIAB OCCUR N/A EACH OCCURRENCE $ HCLAIMS-MADE AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVEE::] OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA 4125234 08/01/10 08/01/11 X TA - TORY LIMITS TI 16EYRR- E.L. EACH ACCIDENT $ 500, 000 E.L. DISEASE - EA EMPLOYE $500,000 E.L. DISEASE -POLICY LIMIT 1 $500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER CANCELLATION City of Fort Collins Purchasing Division Attn: Ed Bonnette P.O. Box 580 (Fort Collins CO 8052 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. AUTHORIZED REPRESENTATIVE ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD Unable to add Additional Insured or Waiver of Subrogation to Umbrella policy as this policy is following form. Unable to change Cancellation wording as this is an infringement on the Acord copyright. This Certificate of Insurance represents coverage in effect and may or may not be in compliance with any written contract. The following cancellation conditions always apply: - 10 days for non-payment of premium - If policy shown, 10 days for Workers' Compensation for fraud; material misrepresentation, non-payment of premium; other reasons approved by the commissioner of insurance.