HomeMy WebLinkAbout109005 POUDRE VALLEY AIR OF NORTHERN COLORADO - INSURANCE CERTIFICATEClient#: 19528
PVAIR
ACORD CERTIFICATE OF LIABILITY INSURANCE
DATE(MM/DW1'YYY)
F
6/10/2011
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(tes) 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
CONTACT
NAME: Kelly Beauvais
Flood & Peterson Ins., Inc.
PHONEFAX
A/C No Esl : 970 266-7121 A/C, Hal: 9705066846
Corporate Mailing Address:
- a
P. O. Box 578
ADDRESS:
PRODUCER
Greeley, CO 80632
CUSTOMER ID a:
INSURER(S) AFFORDING COVERAGE
NAIC if
INSURED
INSURER A: Travelers Insurance Company
Valley Air of Northern
INSURER B: Pinnacol Assurance
Co
Colloraors do, Inc
2416 Donella Court, Suite A
INSURER C:
Fort Collins, CO 80524
INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 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.
TYPE OF INSURANCE
POLICY NUMBER
MWDD/YYYY
XP
MW�D/YYYV
DMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE 1XI OCCUR
4TC0325DS490
10/17/2010
10/17/2011
EACH OCCURRENCE
$1 000 000
DAMAGE TO RENTED
PREMISES Ea occurrence
$300OOO
MED EXP (Any one person)
$10,000
PERSONAL& ADV INJURY
$1,000,000
GENERALAGGREGATE
$2,000 000
GEHL AGGREGATE
POLICY
LIMIT APPLIES PER:
PECTRO LOC
PRODUCTS - COMP/OP AGG
52,000000
$
A
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
BA325D849009
0/17/2010
10/17/2011
COMBINED SINGLE LIMIT
(Ea accident)
$1000000
X
BODILY INJURY (Per person)
S
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
X
X
$
$
A
UMBRELLA LIAB
EXCESS LIAB
)(
OCCUR
CLAIMS -MADE
4TSMCUP32SD84
10/17/2010
10/17/2011
EACH OCCURRENCE
s3,000,000
AGGREGATE
s3,000,000
DEDUCTIBLE
RETENTION 10000
$
X
$
B
WORKERS COMPENSATION
ANDEMPLOYERS'LIABILITY YIN
ANY OFFICER/MEMBEER EXCLUDED? EGUTIVE�
(Mandatory In NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
N/A
4074340
7/01/2010
07/01/2011
X WC STATU- OTH-
E.L. EACH ACCIDENT
$SOD OOO
E.L. DISEASE - EA EMPLOYEE
s500,000
E.L. DISEASE - POLICY LIMIT
s500OOO
DESCRIPTION OF OPERATIONS / LOCATIONS VEHICLES (Attach ACORD 101, Additional Remarks Schedule, B more space is required)
City of Fort Collins Home
Efficient Program
Y 9
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
700 Wood Street
PO BOX 580
1 AUTHORIZED REPRESENTATIVE
Fort Collins, CO 80522
®1988-2009 ACORD CORPORATION. All rights reserved.
ACORD 25 (2009109) 1 of 1 The ACORD name and logo are registered marks of ACORD
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