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HomeMy WebLinkAbout111375 COLORADO LIEN CO - INSURANCE CERTIFICATE (2)ACORE® CERTIFICATE OF LIABILITY INSURANCE 6..� DATE(MM/DD/YYYY) 12/15/2010 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 CONTACT NAME: Marilyn Larson HOEFAX A/CNNo. Ext: (605)342-5555 A/C No: (605)342-7901 Black Hills Insurance Agency, Inc. St. Joseph E-M820 ADDRIESS:marilynlarson@bhagency.org PRODUCER 00001170 T M RID#: CUSTOMER PO Box 3330 INSURER(S) AFFORDING COVERAGE NAIC# Rapid City SD 57709 INSURED A:Re ent Insurance Company 24449 Colorado Lien Company -INSURER INSURERB:General Casualty Com an of WI 24414 A Division of Pete Lien & Sons, Inc. INSURERC: INSURER D PO Box 440 INSURER E : • Rapid City SD 57709 INSURERF: COVERAGES CERTIFICATE NUMBER:CL10121504611 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 TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR CC10219875 1/1/2011 1/1/2012 EACH OCCURRENCE $ 1,000,000 DAMAGE To PREM SES a oc Ecur RENTED $ 300,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER : POLICY X PRO JECT X LOC PRODUCTS - COMP/OPAGG $ 2,000,000 $ B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS BA0219875 1/1/2011 1/1/2012 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ X X Uninsured motorist combined $ 1,000,000 Underinsured motorist $ 1,000,000 B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE CCU0219875 1/1/2011 1/1/2012 EACH OCCURRENCE $ 10, 000, 000 AGGREGATE $ 10, 000, 000 DEDUCTIBLE RETENTION $ 10,000 $ X $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY y / N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/'4 WCO219875 1/1/2011 1/1/2012 X WC STATU- OTH- T RY IMIT R E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EAEMPLOYE $ 100,000 E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) City of Fort Collins is included as additional insured with respect to operations of the named insured as required by contract. (970)221-6586 xFAX City of Fort Collins Attn: Matt PO Box 580 Fort Collins„ CO 80522-0580 CANCELLATION 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 Maguire/MARILY�— ACORD 25 (2009109) ©1988-2009 ACORD CORPORATION. All rights reserved. INS025 (200909) The ACORD name and logo are registered marks of ACORD ,