HomeMy WebLinkAbout398304 LAUREL HILL GIS - INSURANCE CERTIFICATE (2)A /%/inn
'M%l /rtuN CERTIFICATE OF
LIABILITY INSURANCE
.1
F DATE(MMODIYYYY)
11/02/2011
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 endorsement(s).
PRODUCER I
CONTACT
NAME:ME: Katie Klimek
Ewing -Leavitt Insurance Agency
ju"c°NOE,t:970.679.7375 ICNp:866.372.4617
4025 St. Cloud Dr.
E-MAIL
ADDRESS:
Suite 100
PRODUCER 00002465
CUSTOMER ID N:
INSURERS) AFFORDING COVERAGE
NAICN
Loveland, CO 80538
INSURED
INSURER A: Assurance Company of America
19305
LAUREL HILL GIS INC.
INSURERB: Pinnacol Assurance
41190
307 BROSS ST
INSURER : Crump Group
B0265
LONGMONT, CO 80501-S427
INSURER D:
INSURER E
INSURER F:
COVERAGES CERTIFICATE NUMBER: 11/1Z E& Orenewal 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.
INSR
LTR
TYPE OF INSURANCE
ADDL
INSR
SUBR
WVD
POLICY NUMBER
POLICY EFF
MMIDDIYYYY
POLICY E%P
MMIDDIYVYV
LIMITS
A
GENERAL LIABILITY
X COMMEROALGENERALUABILITY
CLAIMS -MADE OCCUR
PPS037575108102/0112011
INCLUDES HIRED & NON-
OWNED AUTO $1,000,000
02/01/2012
EACH OCCURRENCE
$ 1,000,00
DAMAGE TO RENTED
PREMISES Ea ccunence
$ 1,000,000
MEO EXP (Any one pemon)
$ 10,00
PERSONAL & ADV INJURY
$
GENERALAGGREGATE
$ 2,000,00
GENIE AGGREGATE LIMIT APPLIES PER:
PRO -
X POLICY PRO LOC
PRODUCTS - COMP/OP AGG
$ 2,000,000
$
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIREDAUTOS
NON -OWNED AUTOS
COMBINED SINGLE LIMIT
(Ea accident)
$
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
$
$
A
X
UMBRELLA LIAB
EXCESS LIAR
X
OCCUR
CLAIMS -MADE
PPS03757510
02/01/2011
02/01/2012
EACH OCCURRENCE
$ 1,000,00
AGGREGATE
$ 1,000,00
DDucrleLE
RETENTION $
$
$
B
WORKERS COMPENSATION
OFFICERIMEMBER EXCLUDED? PROPRIETORIPARTNEREXANYECUTIVEā¯‘
(Mandatory in NH)
It yes. descnbe under
DE SCRIPTION OF OPERATIONSbelO
N/A
409179
04/01/2011
04/01/2012
X WCSTMITS OTH-
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYE
$ 1,000,00
E.L. DISEASE - POLICY LIMIT 1
$ 1,000,00
C
Errors & Omissions
Liability
US UCS 2644720.1111012612011
1$2,500
10/26/2012
$1,000,000 Each Claim
Deductible
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is rix Wmd)
LCR I IrILAI C nULLICR LAINI,LLLAI IUIN
City of Fort Collins
Attn: John Stephens
PO 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.
REPRESENTATIVE
Kli
1988-2009 ACORD CORPORATION. All Hants:
ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD