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HomeMy WebLinkAbout128847 CRYSTAL LANDSCAPE SUPPLIES INC - INSURANCE CERTIFICATEVr lu Jr
,a►coRO" CERTIFICATE OF LIABILITY INSURANCE
DATE (MMIDD/YYYY)
11/28/11
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 endorsements .
PRODUCER 970-635-9400
PFS Insurance Group -JT 970-635-9401
4848 Thompson Pk wy, Ste 200
Johnstown, CO 80534
Keith Benner
NAMEACT
PHAICONE FA%
Eat: AIC No:
E-MAIL
ADDREss:
PRODUCER CRYST-6
CUSTOMER ID #:
INSURERS AFFORDING COVERAGE
NAIL #
INSURED Crystal Landscape Supplies Inc
6616 N. Garfield Ave.
INSURERA: Plnnacol Assurance
524210
INSURER B:Allied Insurance Company
INSURER C
Loveland, CO 80538-1115
INSURER D:
INSURER E
INSURER F
ua000.
COVERAGES CtK I WIL.A I C INUIVIDIMM.--------
BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED
OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT
WITH RESPECT
TO WHICH THIS
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM
AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE
AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
EXCLUSIONS
DDL B POLICY EFF POLICY EXP
LIMITS
INSR
LTR TYPE OF INSURANCE POLICY NUMBER MMIDDIYYYY MMIDD/YYVY
1,000,000
GENERAL LIABILITY
EACH OCCURRENCE
$
B X GENERAL LIABILITY ACPGLA07543108871 12/0111'1 12101/12
UM-AM70 RENTED
PREMISES Ea occurrence
$ 100,00
COMMERCIAL
$ 5,000
CI.AIMSWADE � OCCUR
MED EXP (Any one person)
PERSONAL B ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2,000,00
PRODUCTS-COMP/OP AGG
$ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
$
X POLICY PRO LOC
COMBINED SINGLE LIMIT
$ 1,000,00
AUTOMOBILE
LIABILITY
(Ea accident)
O
ACPBA75431008871
12101/11
12101112
BODILY INJURY (Per Person)
$
BODILY INJURY (Per accident)
S
NED AUTOS
PROPERTY DAMAGE
$
LED AUTOS
(Per accident)
UTOS
Comp Ded
$ 1,00
NED AUTOS
&RETENTION
Coll Ded
s 1,00
LA LIAB
OCCUR
EACH OCCURRENCE
8
LIAB
CLAIMSlIADE
NIA
AGGREGATE
$
$
IBLE
ION E
X WC STATU- OTH-
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
4041312
06/01/11
06101/12
E.L. EACH ACCIDENT
$ 100,00
100,00
A
ANY PROPRIETORARTNERJEXECUTIVE ❑
IP
NIA
OFFICER/MEMBER EXCLUDED?
E.L. DISEASE - EA EMPLOYEE
$
(Mandatory In NH)
If yes, describe under
E.L. DISEASE - POLICY LIMIT
$ 500,00
DESCRIPTION OF OPERATIONS below
ACPCIM7643108871
12/01111
12/01112
Equipment
5B5,82
g
Inland Marine
1,00
Ded
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (AUach ACORD 101, Additional Remarks Schedule, If more space Is requiretl)
If required by written contract or written re a ement, the City of Fort
Collins is included as Additional Insured for ongoing operations under
General Liability.
CITYOFC
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
City of Fort Collins
215 North Mason Street AUTHORIZED REPRESENTATIVE
Fort Collins, CO 80524
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ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD