HomeMy WebLinkAbout479145 PIPER'S GREASE MONKEY INC - INSURANCE CERTIFICATE (2)OP ID: CC
,acoRO CERTIFICATE OF LIABILITY INSURANCE
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opr08/03o/11
8/031
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 terns and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificates holder in lieu of such endorsement(s). -- -
PRODUCER----- .--. _, __...- �970-879-1363
CONTACT
PHONE - Flue -
C N A C No),
Brown & Brown Insurance 970-879-0239
675 Snapdragon Way, Suite 200
Steamboat Springs, CO 80487
Hugh Scott
E-MAIL-
PRODUCER
c T MERIoa: PIPER-1
INSURERS AFFORDING COVERAGE
NAIC A
INSURED Pipers Grease Monkey, Inc.
INSURERA_Peerless Indemnity Ins Company
18333
Grease Monkey of Loveland #819
INSURER B: Pinnacol Assurance
41190
Grease Monkey of Loveland #90
1100 Richmond Drive
INSURERC:
Ft. Collins, CO 80526
INSURER D:
INSURER E
INSURERF:
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.
ILA
TYPE OF INSURANCE
INSR
VN
POLICYNUMBER
MMIO POLICY
MMIDPOUYEXP
LIMITS
A
ML LIABILITY
MMERCIAL GENERAL LIAB'LIN
CLAIMS -MADE 1XIOCCUR
H-- _ - -' -- - -
X
CBP8504665
_
-
08/06/11
08/06/12
EACH OCCURRENCE
$ 1,000,000
PREMISES EaccLanence
$ 100,00
MED EXP(Any one person)
$ 15,000
PERSONAL B ADV INJURY
5 1,000,00
GENERALAGGREGATE
S - 2,000,000
GENT AGGREGATE LIMIT APPLIES PER:
X POLICY . PRO!'_ LOC
JECT
PRODUCTS - COMP/OP AGO
5 2,000,000
-
9,
AUTOMOBILE
LIABILITY 1,
ANY AUTO -
ALL OWNED AUTOS
SCHEOULEDAUTOS
HIRED AUTOS
NON-OWNEDAUTOS
—
_._ .
COMBINED SINGLE LIMIT
(Ea accident)
E
BODILY INJURY (Per person)
1 5
BODILY INJURY (Per accident)
E
PROPERTY DAMAGE
(Per accident)
E —"
$
E
UMBRELLA LIAR
EXCESS DAB
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
$
AGGREGATE
$
DEDUCTIBLE
RETENTION 5
$
5
B
WORKERS COMPENSATION
AND EMPLOYERS' UABILITYER
ANY PROPRIETOR/PARTNERIEXECUTIVEY❑
OFFICEPJMEMBER EXCLUDED? IN
(Mandatory in NH)
It Gne dead de under
DESCRIPTION OF OPERATIONS deow
NIA
4112366
09/01/11
09/01/12
X WC STAM U OTH-
EL EACH ACCIDENT
E 100,00
E.L. DISEASE - EA EMPLOYE
E 100,00
E.L. DISEASE - POLICY LIMIT
E 500,00
A
(Property Section
CBP8504565
08/06/11
08/06/12
Building 606,77
BPP 128,22
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES Attach ACORD 101. Additional Remake Schedule, if more space Is required)
FAX: 970-221-6707/Certificate holder's ad itional 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
V wit
1gRR-9nn0 ArnRn rn PPn RATlnu All AnHre aa---A
ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD