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HomeMy WebLinkAbout120528 FORT COLLINS TREE CARE INC - INSURANCE CERTIFICATE''I "® CERTIFICATE OF LIABILITY INSURANCE F DATE 3/30/2011�) 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 _ ... _ .. First 1'alnstreet II1SllranCE ; t: •..w. 512-4th-AVenlle - ---" -'---- CONTACT- I NAME: (AICONN .EcU. 303. 776. 5122 (ABC No); 303.776.5495 E-MAIL ,,... ADDRESS: J. PRODUCER J: n'-:-Irn,_-,�_1 .:• JD_#; P.O. 'Box 847--____ _ _ --_.� - - - Longmont CO 80SO2. -CUSTOMER INSURER(S)AFFORDING COVERAGE 1 NAICkr'`- INSURED' - INSURER A:HartfOrd Fire Insurance Co INSURER B:Pinnacol Assurance • Fort Collins Tree Care, Inc INSURER C: 301 East Douglas Road INSURER D: INSURER E : INSURER F: Fort Collins CO 80524 COVERAGES CERTIFICATE NUMBER:11/12 G/L Auto W/C 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 AINDR SMD POLICY NUMBER MMIDDNYYY MM/DDIYYYY LIMITS LTR TYPE OF INSURANCE A. GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X1 OCCUR 34UUNSR3900 - _ ��✓P3v •,_'•________.___ 03/05/2011 __• _. _ .. I03/05/2012 _--_ _ -_ EACH OCCURRENCE DAMAGE PR EM SESOEa occurrence $ 11 000, 000 S 300:000 MED EXP(Any one person) Is 10,000 PERSONAL &ADVINJURV $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 .._._ GEN'L AGGREGATE LIMIT APPLIES PER'. PO'LICYF7-1 PROn - JECTLOC PRODUCTS-COMP/OP AGO $ 2,000,000 $''':. '.. A AUTOMOBILE LIABILII ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS 34UUNSR3900 ,';:. - ' 03/05/201103/05/2012 - -' - COMBINED SINGLE LIMIT '(Ea accident) $ 1,000,000 - X, BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ X X $ UMBRELLA LIAB EXCESS LAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ I $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN NY PROPRIETOR/PARTNER/EXECUTIVE AOFFICER/MEMBER EXCLUDED' (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N I A I4068879 4068879 05/01/2011'05/01/2012 OS/Ol/201005/Ol/2011 OTR Y T RV LAMIi E.L. EACH T ACCDEN $ 100, 000 E.L. DISEASEEAEMPLOYEE 8 100,000 E.L. DISEASE -POLICY LIMIT $ SOO 1 000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) City of Fort Collins as Additional Insured as required by written contract per General Liability policy form. (970)221-6707 City of Fort Collins Purchasing Division P 0 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 ACORD 25 Pat Deaver/tMMd- ©1988-2009 ACORD CORPORATION. All rights reserved. IIYJVL. ILWYNJ) 111E MVVRV IICIIIC GIIU IUUU dIC rCgIJIY•rBU INdrK5 UL AI URU