Loading...
HomeMy WebLinkAbout460607 CAMELOT CLEANERS - INSURANCE CERTIFICATE (3)ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 04/22/2011 PRODUCER (970) 377-0638 Squires Insurance Solutions LLC 4u 4025 Automation Way Bldg B, Suite 4 Fort Collins CO 80525- THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC# INSURED Dean Archambo, dba Camelot Cleaners 2649 H Mulberry St, Ste 11A Fort Collins CO 80524- INSURERA: Hartford Casualty Ina Cc INSURERS. Sentinel Insurance Co INSURER C: Pinnacol Assurance INSURER D: 1 INSURER E: rnVFRAI-FS 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR ADD'L INSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATEIMMIDDM/) POLICY EXPIRATION DATE(MM/DDIYY) LIMITS A X GENERAL LIABILITY 34 SBA IS9881 08/29/2011 08/29/2012 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY RENTEDDAMAGE TO PREMSES(Eaoccurre occurrence) $ 300, 000 CLAIMS MADE Fx_] OCCUR / / / / MED EXP (Any one person) $ 10,000 PERSONAL B ADV INJURY $ 1,000,000 GENERALAGGREGATE $ 2,000,000 GENL AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $ 2, 000,000 POLICY JJECCT LOC / / / / BPLI 5,000 B X AUTOMOBILE LIABILITY ANY AUTO 34 DEC JJ784 08/29/2011 08/29/2012 COMBINED SINGLE LIMIT (Ea accident) $ 1, 000, 000 BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS / / / / X X BODILY INJURY (Per accident) $ HIREDAUTOS AUTOS / / / / XNON-OWNED PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLYEAACCIDENT $ OTHER THAN EA ACC $ ANY AUTO / / / / AUTO ONLY: AGG $ A X EXCESSIUMBRELLA LIABILITY 34 SBA IS9881 08/29/2011 08/29/2012 EACH OCCURRENCE $ X OCCUR CLAIMS MADE AGGREGATE $ UMBRL $ 2,000,000 X DEDUCTIBLE 10,000 / I / I $ is RETENTION $ 1 C WORKERS COMPENSATION AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE 4142182 08/29/2011 09/01/2012 X WC STATU- DTH- TORY LIMITS ER E L. EACH ACCIDENT $ 100,000 EL. DISEASE - EA EMPLOYEE 100,000 OFFICER/MEMBER EXCLUDED? / / / / If yes, describe under SPECIAL PROVISIONS below EL DISEASEPOLICYLIMIT $ 500,000 p OTHER BOPPR 34 SBA IS9881 08/29/2011 08/29/2012 DESCRIPTION OF OPERATIONSILOCATIONSfVEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS Contract #7037 - Dry Cleaning Services. Certificate Holder is listed as Additional Insured on the policy as per policy force and conditions. (970) 221-6775 (970) 221-6707 Purchasing Department City of Fort Collins PO Box 580 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE Fort Collins CO 80527- ACORD 25 (2001/08) INS025 (0108).06 AUTHORIZED REPRESENTATIVE �3 © ACORD CORPORATION 1988 Page I of 2 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsemenl(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2001108) INS025(oioa).o6 AMS Page 2 of