HomeMy WebLinkAbout129302 HAGEMAN EARTH CYCLE - INSURANCE CERTIFICATE (9)a.uentar_ zraIus
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ACORD- CERTIFICATE OF LIABILITY INSURANCE
°11/r3/20 0YY)
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:
P. O. Box 578
CONTA T NAM Kell Beauvais
PHLAICONN 970 266-7121 No : 9705066846
ADDRESS-
Greeley, CO 80632
CUSTOMER ID r:
INSURER(S) AFFORDING COVERAGE
NAIC J!
INSURED
INSURER A: Continental Western Group
Hageman Earth Cycle, Inc.
3501 E. Prospect Road
Fort Collins, CO 80525
INSURERS: Pinnacol Assurance
INSURER :
INSURER 0
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.
TYPE OF INSURANCE
POLICY NUMBER
POLICY
MWDDNYY
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE a OCCUR
X PD Ded:500
CWP234489328
2/01/2010
12/01/2011
EACH OCCURRENCE
S1 000000
DAMAGE TO RENTFI)
PREMISES Ea occurrence
$100 000
MED EXP (Any one person)
SS 000
PERSONAL & ADV INJURY
$1 000,000
GENERAL AGGREGATE
52,000 000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY PRO- LOC
PRODUCTS - COMP/OP AGG
$2 00O 000
$
A
AUTOMOBILE LIABILITY
X ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
X HIRED AUTOS
X NON -OWNED AUTOS
X Drive Other Car
CWP234489328
2/01/2010
12/01/2011
COMBINED SINGLE LIMIT
(Ea accident)
$l 000 000
BODILY INJURY (Per person)
S
BODILY INJURY (Per accident)
S
PROPERTY DAMAGE
(Per accident)
S
S
s
A
UMBRELLA LIAR
EXCESS LIAR
X
OCCUR
CLAIMS -MADE
CU236140828
2/01/2010
12/01/2011
EACH OCCURRENCE
s2,000,000
AGGREGATE
s2,000,000
DEDUCTIBLE
RETENTION 9
$
S
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y/
ANY PRO RIIETOR EXCLUDE/E ECUTIVE❑NN
(Mandatory In NH)
It Ordescribe under
RIPTION OF OPERATIONS below
N/A
4036218
0/01/2010
10/01/2011
x JWC STATU• I OTH-
E.L. EACH ACCIDENT
$100000
E.L. DISEASE - EA EMPLOYEE
S100 000
E.L. DISEASE - POLICY LIMIT
5500 000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, It mom space Is required)
Re: Snow Removal
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 Department
256 W. Mountain Ave. AUTHORIZED REPRESENTATIVE
Fort Collins, CO 80521 11
01988-2009 ACORD CORPORATION. All rights reserved.
ACORD 25 (2009/09) 1 of 1 The ACORD name and logo are registered marks of ACORD
#S575346/M575340 KLB