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Home My WebLink About332904 JAG'S ENTERPRISES INC - INSURANCE CERTIFICATE (2)OP ID: MM A64. R CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY) 02/23/11 THIS CERTIFICATE IS ISSUED AS A MATTER OF'l,MFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR R'_-GATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCEjJOES 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 endorsements . PRODUCER-970-674-8825 Renaissance Insurance Group P O BOX 476 �. 970-674-8826 101 E Main Street Windsor, CO 80550 Jay W. Helzer - / CONTACT PHONE FAX A_,c No, Ext): FAX No): E-MAIL• ADDRESS: PRODUCER CUSTOMER ID O: JAGSS-1 INSURER(S) AFFORDING COVERAGE NAIC III INSURED Jag's Enterprises, Inc. INSURER A : Western Heritage Insurance Co. Jag's Equipment Investment 7951 W.28th Street Greeley, CO 80634 INSURER B: Colorado Casualty 41785 INSURER C:PinnacolAssurance INSURER D INSURER E : INSURER F : COVERAGES ICFRTIFICATF NIIMRFR• DFVICInrd KI IMRFD- 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 rypE OF INSURANCE ADDL SUER I POLICY NUMBER POLICY EFF 1MMIDDrYYYrY1 POLICY EXP (MM/DDfYYYY)LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR SCP0785596 01/27/11 01/27/12 _ EACH OCCURRENCE $ 1,000,00 DAMAGE TO RENTED PREMISES Ea occurrence $ 100,00 MED EXP (Any one person) $ 5,00 PERSONAL B ADV INJURY $ 1,000,00_ . GENERAL AGGREGATE- $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO LOC PRODUCTS-COMP/OP AGG $ _ 2,000,00 $ B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIREDAUTOS NON-OWNEDAUTOS BA2593684 01/27/11 01/27/12 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,00 BODILY INJURY (Per person) I $ X BODILY INJURY (Per accident) E PROPERTYDAMAGE (Per accident) $ X X $ $ UMBRELLA LIAB EXCESS LIAR OCCUR CLAIMS -MADE N/A EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ s C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNEWEXECUTIVE YININ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA �411114627 06/01/10 06/01/11 X WC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT E 1,000,00 E.L. DISEASE - EA EMPLOYEE $ 1,000,00 E.L. DISEASE -POLICY LIMIT 1 $ 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) CITYOFF City of Fort Collins Engineering Department P.O. Box 580 Fort Collins, CO 80524-0580 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 EARN . f 4 i ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD JAGSS-1 PAGE 2 NOTEPAD INSURED'S NAME Jag's Enterprises, Inc. OP ID: MM DATE 02/23/11 Unable to change Cancellation wording as this Is an Infnngement 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 p orkers' Compensation for fraud; material misrepresentation, non-payment of premium; other reasons approved by the commissioner of insurance.