HomeMy WebLinkAbout121309 FOOTHILLS TREE EXPERTS INC - INSURANCE CERTIFICATE (6)ACORD CERTIFICATE OF LIABILITY
INSURANCE
MMI
DATE 19/2011 1
06/09/201
PRODUCER (970) 377-0638
Squires Insurance Solutions LLC
9
4025 Automation Nay
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 II
INSURED
Foothills Tree Experts Inc.
3600 Canadian Parkway
Fort Collins CO 80524-
INSURERA. Hartford Fire Insurance
INSURER B: Sentinel Insurance Cc Ltd
INSURERc: Pinnacol Assurance
INSURER D:
INSURER@
COVFRAC.FS
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR i HE POLICY PERIOD INDICATED, NO WITHSTANDING 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
DO'L
NERD
TYPEOFINSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE(MMMDIYY)
POLICY EXPIRATION
DATE IMMIODIYY)
LIMITS
A
X
GENERAL LIABILITY
34 DON QY8384
06/15/2011
06/15/2012
EACH OCCURRENCE
$ 1,000,000
X COMMERCIAL GENERAL LIABILITY
CLAIMS WOE OCCUR
/ /
/ /
P
DREMMISES AAGETOEa RENTEDpcwrmnce
$ 100,000
MED EXP (MY wiapsapn)
$ 5,000
PERSONAL$ ADV INJURY
$ 1.000.000
GENERAL AGGREGATE
$ 2,000,000
GEN L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGO
$ 2,000,000
RO-
POLICY JECT TOO
/ /
/ /
NOMND
B
X
AUTOMOBILE
X
LIABILITY
ANY ALTO
34 DON QY8384
06/15/2011
06/15/2012
COMBINED SINGLE LIMIT
(Ea accident)
S 1.000. 000
BODILY INJURY
(Per peeon)
$
Al I. OWNED AUTOS
SCHEDULED AUTOS
/ /
/ /
HIRED AUTOS
NOWOWNED AUTOS
/ /
/ /
BODILY INJURY
(Per accident)
$
PROPERTY DAMAGE
(Per accident
$
GARAGE DABILTY
AUTO ONLY - EA ACCIDENT
$
ANYAUTO
n
/ /
/ /
OTHERTHAN EAACC
$
AUTO ONLY: AGG
$
EXCESSIUMBRELLA LIABILITY
EACH OCCURRENCE
S
AGGREGATE
S
OCCUR ❑ CLAIMS MADE
$
$
DEDUCTIBLE
/ /
/ /
$
RETENTION S
C
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
4080571
05/01/2011
05/01/2012
X ITORYLAITB ER
EL EACH ACCIDENT
S 100,000
ANY PROPRIF.TORIPARTNERIEXECUTNE
OFFICERIMEMBER EXCLUDED?
II'M, de...be under
SPECIAL PROVISIONS dolow
/ /
/ /
E.L DISEASE. EA EMPLOYEE
$ 100. 000
E.L. DISEASE -POLICY LIMIT
$ 500,000
p
OTHER PROP
34 DON QY8384
06/15/2011
06/15/2012
BUSER 50,000
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLEWEXCLUSIONS ADDED BY ENDORSEME WISPECIAL PROVISIONS
Tree trimming operations. Certificate Holder is listed as Additional Insured on the policy as required by written
contract or permit as per policy farms and conditions.
John Stevens
City of Fort Collins
Forestry Division
413 South Bryan Ave
(2001/08)
I NS025 (DIDS).05
(970) 221-6707 I 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 LABILITY OF ANY KIND UPON THE
AUTHORIZED REPRESENTATIVE 1-2 _
el
Page I pf Z
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.
AGORD 25 (2001108)
INS025 t0*elbe AMS P,.2 d2