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Home My WebLink About148485 ACCU CLEAN FLOOR CARE - INSURANCE CERTIFICATEJUN-06-2011 12:51 FromiRMERICRN FRMILY INS To:2216707 Pase:1/1 1 CERTIFICATE OF LIABILITY INSURANCE American Family InsuranceCompany ❑ American Family Mutual Insurance Company if selection box is not checked. 6000 American Pky Madison, Wisconsin 53783-DO01 Insured's Name and Address Agents Name, Address and Phone Number (AgtJDist.) Cooper, Randel Jennifer Clarke (970) 221-0897 736 Gallup Rd. 301 W Magnolia St Fort Collins, CO 80521 Fort Collins, CO 80521-2804 (018/316) This cartif Bate is issued as a matter of information only and confers no rights upon the Certificate Holder - This Certificate does not amend, extend or after the coverage afforded by the policies listed below. COVERAGES .. ..F . nris is to wmfy mat Rdinn Of 0$eanw kRed below nave beer jawed W de Imured named above for true pd.I' cue Mmdd MiTCO d, norwigl$Wndlrg amr rgRuremPllt, term IX wlblCpn of any, cadrac Or miler docvmem with maj:wO m w on miecerlS®te may ba awed or may Damn,me im:uremce aHdrdad by ate SX40aS deacrbed heron% wblecs m al me tense, exdusiau, and aondRvns Of won %%IOPa. TYPE OF INSURANCE POLICY NUMBER LIMITS OF LIABILITY EFFECnvE ExPIRAITON rya ,r Lw D v. Homeowners/ eodly Injury and Pmpary Damage Mobilehomeowners Liability Each Orxvnence $ 000 Boatowners, Liability Bodlr Injury and Property Damage E=Occurrence $ Iwo Personal Umbrella Liability eamly Injury and Property Damage Eecn ocumence $ ,000 FarmfRanch Liability Fan uaMtty s Personal Uautty Eam occurrence $ '000 Farm Employers Uabdsty Eam Occurrence $ 000 Workers Compensation and statutory' «ass.eee. Each Amdent $ '000 Employers Liability t Disease - Each E,npbyes $ ,000 D' we • Pdky Uma $ 1000 General Liability General Nilregare $ 600,000 I91 Commercial General Liability (Occurrence) El05-X77168-01-00 ❑ 3/18/2011 3/18/2012 Prddum- Completed O"MramsAggregate $ 600 000 Perwnd and Ad+emsm Injury$ 300 Eam Ocdmence $ 300,000 Dam mPremises Remedmyou $ 100 000 Mediwt Expense (Any One Person) $ 5 000 Businessowners Liability Earn Owt'nencett $ ,000 Aggrsgatett $ ,00fo Liquor Liability Common Cause Lunn $ '000 e Umn $ 1000 Automobile Liability ❑ Any Auto ❑ All Owned Autos Badly iNury -Eem Pefson $ 000 Body, Injury - Eson Acbdem $ ,000 ❑ Scheduled Autos El Hired Auto Prop" Damage $ ,000 ❑ Nonowned Autos ❑ avduy In„ try and Prtyedy Damage Combined $ 1000 Excess Liability ❑ Commercial Blanket Excess Each Om. w A;Aggregae $ ,000 Other (Miscellaneous Coverages) DESCRIPTION OF OFE"TIONSILOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS tfeeindvAuaaPnoe *.aa,ai Rave ❑FMB col City of Fort Collins is listed as additional insured on endorsement CG2010 ttpm ,Dxw. W operators ""Me d actual b ea:h e°pGINK! 4m1 YN k ro;gad In Gdiq agregat, ' CERTIFICATE HOLDER'S NAME AND ADDRESS � CANCELLATION C' of Fort CollinsLJ dY PO Box 580 houW any o the above descrihed policies ors cancelled before the expiration data thereof the company will endeavor to mail'( days) written notice to the iertificate Holder named, but failure to mail such Fort Collins, Co 80522 Attn: John Stephen notice shall impose no obligation or liaolkly of any kind upon Me company, its agents or representatives. -WO days unless different number of days shown, Fax:221-6707 MThis certifies coverage on the date of issue only. The above described policies are subject to cancellation in conformity with their terms and p the laws of the state of issue. DATE ISSUED AUTHORIZED REPRESENTATIVE 6/6/2011 Jennifer Lamb Clarke I LM1 CA F/M bnnL ern rIRRFY, peal 7111 06/06/2011 10:36:19 AM PINNACOL ASSURANCE PAGE 2 OF 3 ACORD- CERTIFICATE OF LIABILITY INSURANCE °ATE,MM OD DerosrzDll PER PINNACOL ASSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY 501 Lowry BNtl 7501E o Denver. CO 80230-7006 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 NAIL# INSURED RANDEL S COOPER INSURERA PINNACOL ASSURANCE 61190 INsuRERe 736 GALLUP ROAD ERIC FORT COLLINS, CO 80521 INSURER INSURER E'. COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDNG ANY REOUIREM ENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMM ENT 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 CLAMS. INSR AODL PWCY EFFECTIVE PCUCYEXPIRAION ON INSHD TWEOFINSUPANCE POUCYWM9ER DATE ANUD MTEwMIOMM! UNITS OENEML LIABILITY EACH OCCURRENCE DAW,GE TO RENTED COMMERCIAL GENERAL UASIUTV CWMSMAOE OCCUR PREMISES MEO EW An an<Penon PFAS"L SAM INURY CENL AGGREGATE UMITAPPUERS PER L£NERALAGGREGATE PRODUCTS - COMPIOP ADS POUCV PHWECTn LOS AUTO.WIRU LIABILITY CCMBWEO SINGLE UMIT ANY AUTO IEa.OIR, DODLYINIURY AU-COINEDAUTOS SCHEWLEDAUTOS enm BODLYIN.URY HREDAUiOS M1VNGYNED AUTOS IF".f Rl PROPERTYC.OE �PWaxumo "MOE LIABILITY AUTOONLY-EA ACCIDENT OTHER THAN EAACC ANYAUTO AUTO ONLY AG EXCESSJUWAEW WBILITY OCCUR CWMSMA➢E EACH OCCURRENCE AGGREGATE DEDUCTIDIE RETENTION f WORI(ERa CDMEMyTIDH AND WCSTART OTHER A EWLOVERI WBILItt ANY FFOFRIETOPPMTNEPIE%ECUTIVE /001894 061012017 061012012 TORTUNTS ACHAC E.LEALHACCIOENT j100,000 OFFlCEFIMEMBER IXLLWEOt ELDSEASE-EAEMPLOYEE $100,000 1IYq genie EeemOe utgel SPECIALPRO/190NB Etlaw E LDISEASE-POUCVUMIi 3500000 OTHER DESCRIPTION OF OPERATIONSAUCCATIONSIMEHICLESIEXCLUSIONS ADDED BY ENDORSEMENMPECIAL PROVISIONS Reference: Accu-Clean CERTIFICATE HOLDER CANCELLATION 1315077 SHOULDANY OF THEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Fort Collins THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR T John Stephen PO Box 580 Fort Collins CO 80522 MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO TH LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Timothy Hurd ACORD 25(2001108) Underwriter ACORD CORPORATION 1988 06/06/2011 10:36:19 AM PINNACOL ASSURANCE PAGE 3 OF 3 CERTIFICATE HOLDER COPY City of Fort Collins John Stephen PO Box 580 Fort Collins CO 60522 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 endorsement(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.