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HomeMy WebLinkAbout119699 GALLEGOS SANITATION INC - INSURANCE CERTIFICATEWCASTLEB 1411coRO CERTIFICATE OF LIABILITY INSURANCE DAT 531//31/DD/Y2011 1 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 CoBiz Insurance, Inc.- CO 821 17th St. Denver, CO 80202 CONTACT NAME: PHONE FAX ac. No. Eat: 303 988-0446INC No): (303) 988-0804 AD RIESS: PRODUCER GALLSAN-01 CUSTOMER,,,: INSURERS AFFORDING COVERAGE NAIC e INSURED INSURER A: Cincinnati Insurance Companies INSURER B: Pinnacol Assurance 41190 Gallegos Sanitation, Inc Mark Glorioso 1941 Heath Pkwy 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 15 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE AD BR POLICY NUMBER POLICY EFF MMIDD/YVYY POLICY EXP MMIDONYYV UNITSLTR A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY 71 CLAIMS -MADE FxIOCCUR CAP5221860 511/2011 51112012 EACH OCCURRENCE $ 1,000,000 PREMISES Ea ocolnence $ 100,000 MED EXP(My one Parson) $ 5,000 PERSONAL 8 ADV INJURY $ 1.000,000 GENERAL AGGREGATE $ 2,000,000' GENT AGGREGATE LIMIT APPLIES PER: X POLICY PRO- LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS CAP5221860 - 5N12011 511/2012 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000� X BODILY INJURY (Per person) $ BODILY INJURY (Per accitlenry $ PROPERTY DAMAGE (Peraccitlent) $ $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE CAP5221860 5/112011 511/2012 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000, DEDUCTIBLE RETENTION $ $ X $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITYM[TS ANY PROPRIETORIPARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A 4148231 611/2011 611/2012 X WC STATU- OTH- ER E.L. EACH ACCIDENT $ 1,000,000 E.L DISEASE-EAEMPLOVEE$ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional RemaAs Schedule, If more space Is requlred) CERTIFICATE HOLDER CANCELLATION City of Fort Collins Finance Department) Sales Tax Division P.O. Box 580 Fort Collins, CO 80522-0580 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 REPRESENTATIVE L © 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD