HomeMy WebLinkAbout279796 COCAL LANDSCAPE SERVICES INC - INSURANCE CERTIFICATEACOR5P CERTIFICATE OF LIABILITY INSURANCE
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DATE(MM/DD/YYYY)
112/27/2010
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
Van Gilder Insurance Corp.
1515 Wynkoop, Suite 200
Denver CO 80202
CONTACT
NAME:
PHONE FAX
A/C No Ext: - 7- AIC,No: - l- 2
E-MAIL
ADDRESS:
PRODUCER
CUSTOMER ID #:
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURED
COCal Landscape Services, Inc.
CoCal Landscape Construction Co.
INSURER A: Travelers Property Casualty CO
25674
INSURER B: Pinnacol Assurance
INSURER C: Travelers Indemnity Company (C
25658
12570 E. 39th Ave.
INSURER D:
Denver CO 80239
INSURER E
INSURER F
COVERAGES CERTIFICATE NUMBER:717867392 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.
ILTR
TYPE OF INSURANCE
ADDLSUBR
NSR
WVD
POLICY NUMBER
MMIDDY/YYYY
MM/DDIIYYYY
LIMITS
C
GENERAL LIABILITY
DTCO2986PO68PHXll
1/1/2011
1/1/2012
EACH OCCURRENCE
$1,000, 000
X COMMERCIAL GENERAL LIABILITY
DAMAGEPREMISESS ( RENTED
Ea occurrence
$ 300, 000
MED EXP (Any one person)
$10, 000
CLAIMS -MADE 1_X_1 OCCUR
PERSONAL & ADV INJURY
$1, 000, 000
GENERAL AGGREGATE
$2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
$2,000,000
POLICY X PRO- LOC
jECT
$
A
AUTOMOBILE
LIABILITY
DT8102986PO68TIL11
1/1/2011
1/1/2012
COMBINED SINGLE LIMIT
(Ea accident)
$1, 000,000
X
ANY AUTO
BODILY INJURY (Per person)
$
ALL OWNED AUTOS
BODILY INJURY (Per accident)
$
X
SCHEDULED AUTOS
HIRED AUTOS
PROPERTY DAMAGE
(Per accident)
$
X
NON -OWNED AUTOS
$
$
C
X
UMBRELLA LIAB
X
OCCUR
DTSMCUP2986PO68TIL11
1/1/2011
1/1/2012
EACH OCCURRENCE
$5,000,000
EXCESS LIAB
CLAIMS -MADE
AGGREGATE
$5, 000, 000
DEDUCTIBLE
$
$
X
RETENTION $10,000
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? ❑
N / A
4136357
1/1/2011
1/1/2012
X WC LIMIT OTH-
RY LIMIT ER
E.L. EACH ACCIDENT
$1, 000, 000
E.L. DISEASE - EA EMPLOYE
$1, 000,000
(Mandatory in NH)
If yes, describe under
E.L. DISEASE - POLICY LIMIT 1
$1, 000, 000
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
If required by written contract or written agreement, the City of Ft. Collins, its officers and employees
are included as Additional Insured for ongoing operations under General Liability.
CERTIFICATE HOLDER CANCELLATION
City of Ft. Collins;City's Director of
Purchasing & Risk Mgmt
P.O. Box 580
Fort Collins CO 80522
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED
IN ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
(01988-2009 ACORD CORPORATION. All rights reserved.
ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD