HomeMy WebLinkAbout479145 PIPER'S GREASE MONKEY INC - INSURANCE CERTIFICATEOP ID: CC
CERTIFICATE OF LIABILITY INSURANCE
DATE
07106A�
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' INS U RER(S), AUTHORIZED..
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMP,ORTANT:,', If.the:certificate- holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subjecfto.'C
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate doesnot confer rights to the:
certificate-holdec.in lieu of such endorsement(s)'. - -
PRODUCER 970-879-1363
Brown 8: Brown Insurance 970-879-0239
675 Snapdragon Way, Suite 200
Steamboat Springs, CO 80487
Hugh Scott
CONTACT - -- -
PHONE Ua No:
E-MAIL
ADDRESS:
PRODUCER PIPER-1
CUSTOMER ID p:
INSURERS AFFORDING COVERAGE
NAIC#
INSURED Piper's Grease Monkey, Inc.
INSURERA: Peerless Indemnity Ins Company
18333
Grease Monkey of Loveland #819
INSURER B:PinnacolAssurance
41190
Grease Monkey of Loveland #90
1100 Richmond Drive
INSURERC:
-
Ft. Collins, CO 80526
INsuftERo:
INSURER E :
INSURER F:
CnVFRAn FS CFRTIFICATF Nt1MBER- 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.
MSR
LTR
TYPE OF INSURANCE
IN
POLICYNUMBER
MMIDCV EFF
MMUGY FXP
LIMITS
GENERAL UABILITY
EACH OCCURRENCE
5 1,000,000
A
X COMMERCIAL GENERAL LIABILITY
X
CBP8504565
o9/o6n1
08/06I12
PREMISES (Ed o¢unence
5 100+00
MED EXP(Any one person)
$ 15,000
CLAIMS -MADE �X OCCUR
PERSONAL BADVINJURY
S- 1,000,000
._- _-_ _. .. _ __. _-.___.
.-.__
_._ _._".:-_. _. -_ ._•.
,..
.. -. -
- _
GENERAL AGGREGATE r.
$1 a 2,000,000
GEN'LAGGREGATEE. LIMIT APPLIES PER-. -
_
-
PRODUCTS-COMP/OP AGG'
8r'':1' 2,000,000
$
X .i POLICY .,PRO- - LOC'+
_
-
AUTOMOBILE
LIABILITY' 'fj
-
COMBINED SINGLE LIMIT--`
$
-
(Ea accident)''
ANY AUTO
--
-
BODILY INJURY (Per person)
$
ALL OWNED AUTOS
—'
BODILY INJURY (Per accident)
3
SCHEDULED AUTOS
HIRED AUTOS
PROPERTY DAMAGE
(Per ecedenl)
5
is
NON-OWNEDAUTOS
5
UMBRELLA LIAB
H
OCCUR
EACH OCCURRENCE
$
AGGREGATE
$
EXCESS LIAB
CLAIMS -MADE
DEDUCTIBLE
5
s
RErENTION $
B
WORKERS COMPENSATION
ANOEMPLOYERS'LIABILITY
ANY PROPRIETORIPARTNER/F_XECUTIVEY�
OFFICERIMEMBER EXC W QED?
(Mandatorym NH)
NIA.
4112366
09/01/10
09I01/11
X WCSTATU- OTH-
RY IMIT R
E.L. EACH ACCIDENT
$ 100,000
E.L. DISEASE - EA EMPLOYE
$ 100,000
If yas, describe under
DESCRIPTION OF OPERATIONS be.
EA. DISEASE -POLICY LIMIT
1 $ 500,00
Property Section
CBP8504565
OB/O6/11
OB/O6/12B
ing 28,226A
PP
128,226
DESCRIPTION OF OPERATIONS LOCATIONS VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more space is required)
FAX: 970-221-6707/Certificate holder's additional insured/designated
organization interest included only as pertains to the insured's scope of
operation in regard to the city's fleet of vehicles.
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 REPRESENTATIVE
. N+�rtt2
G'
n loRR_9nno ArnRn r.OPPOPATInN All riinhf. rPCPNPA
ACORD 26 (2009/09) The ACORD name and logo are registered marks of ACORD