HomeMy WebLinkAbout276712 FINE TREE SERVICE - INSURANCE CERTIFICATE (3)Aa CERTIFICATE OF LIABILITY INSURANCE
6/15/201115/2011
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 endomement(s).
PRODUCER
CONTACT Matt Di ewer
Colorado B➢4 insurance Agency, Inc.
PHONEIAXN,�I.(970)223-0924 FA1
�AIC Nnl (9701247.2231
1075 W HOrRd, Ste 106
E-MAILaetooth
ADDRESS, isatt - diemer@hanko£thevest. com
PRODUCERCUSTO.IDL, a 00059323
Fort Collins r CO 80526
INS U RE R(5) AFFORDING COVERAG E NAICtl
INSURED
INSURER A:HartfOrd [The) _
INSURER B:Pinnacol Assurance 41190
Fine Tree Service Inc.
3060 Lake Canal Ct
_
INSURER c:INSURER
D: -
INSURER E:
Fort Collins CO 80524
Ix, RERF:
COVERAGES CERTIFICATE NUMBER:2011-2012 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.
lim
TYPEOFINSURANCE
DOL
NSA
SUER
jiWo
NUMBER
POLPOLICY
Mu�IOYIYEYFYFY
N�VDD
UM"
GENERALUAIUUYY
EACH OCCURRENCE 5 1,000,000
A
X COMMERCIAL GENERAL LU18aITV
CIAMSiMAOE CC OCCUR
34DONSR4541
/5/2011
/5/2012
,AMA ETO REN,E nce IS 300, 000
MED EXP Lny . wsw S 10, p00
PERSONAL J. ADV INJURY S 1,000,000
�.
GENERAL AGGREGATES 2,000,000
GENL AGGREGATE LIMIT APPLIES PER
Xi POLICY PRO- LOC
PRODUCT$ - COMPIOP AGG
5 2,000,000
5
AUTOMOBILE
X;I
LUIBIUTY
ANY AUTO
CCMBINED SINGLE LIMIT
(Ea wdcenU
$ 500,000
BODILY INJURY(Ow Pelson)
5
A
ALL OWNED AUTOS
40DNSR4S41 7/5/2011
/5/2012
BODILY INJURY(Per Adadam)
$
SCHEOULEO AUTOS
PROPERTY DAMAGE
(Pn acc ZC U
S
%t
HIRED AUTOS
X
NON -OWNED AUTOS
Unne eDmdtmier dmNned
5 500,000
s
UMBRELLA LAe
OCCUR
EACH OCCURRENCE 5
EXCESS 11AB
CLAIM1IS- D'
.,- -
AGGREGATE ;s
DEDUCTIBLE
E
_
5
0.ETENTION E
B
WORI(ERSCOIMPENSATION
AND EMPLOYERS'UAeI;ITY YINFIR
ANY PROPRIETCR/PARTNER/EXECUTIVE
nkwn,*OFFiCER in NH)EXCLUOE01
°tr 1O
IIyes, DA
NIA
063365
7/1/2011
/1/2012
\NG STATU- O7R
E.L. EACH ACCIDENT
g 0000
E.L. DISEASE - EA EMPLOYE
10O
] l0O 000
EL OI$EA$E- POLICY LIMIT I
3 $p0 000
DESCRIPTIIPTIOF
ON OF PERATION$belax
O
DESORIPTONOFOPERATIONS/LOCAnONSIVEHICLSS lAmch ACOR0151, AOettIonM RemeHro Scheduk,Amort ¢pau is requvea)
(970)221-6707
City of Fort Collins
P.O. 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 REPRESENTAYNE
Brandon Avery/MDFC
ACORD 26 (2009109) 01988.2001
INS025(20000B) The ACORD name and IDGo are roolstered markN of AC
100/100d wBLS 01 I,QZ Sl DRf IEZZL0Z0101 M 33NpNOSNI Mn-OnumninI
All rights reserved-