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HomeMy WebLinkAbout106089 WESTERN STATES LAND SERVICES - INSURANCE CERTIFICATEOP ID: JS 144CoRo° CERTIFICATE OF LIABILITY INSURANCE onr12/12/112/nvvr) 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 303-429-3561 Richards, Seeley, 8 Schaefer, 303-427-0611 Inc. NAME: CONTACT PHONE (FM _(AIC No Eat: A/C No: 3640 W. 112th Avenue Westminster, CO 80031 B John Seeley E-MAIL ADDRESS: PRODUCER WESTE-1 CUSTOMER ID N: INSURERS AFFORDING COVERAGE NAIC N INSURED Western States Land Services INSURER A: American States Insurance 505 N Denver Avenue INSURER B:PinnacolAssurance 41190 Loveland, CO 80537 INSURER C : ' 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 IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRLICY LTR TYPE OF INSURANCE i D mn II POLICY NUMBER EFF MM/DD/YYYY MMLIC IDOYI EX P LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 51 OCCUR 02BP85670920 _ 12/15/11 12/15/12 EACH OCCURRENCE E 1,000,000 JAMNUETU R NT D PREMISES Ea occurrence $ 250,000 MED EXP (Any one person) E 10,000 PERSONAL S ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- n LOG PRODUCTS - COMPIOP AGG E 1,000,000 E A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNEDAUTOS 24CC2767412 01/30/12 01/30/13 COMBINED SINGLE LIMIT (Ea accident) E 1,000,00 X BODILY INJURY (Per person) S BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ X X $ S UMBRELLA LIAR EXCESS LIAB Ll OCCUR CLAIMS -MADE EACH OCCURRENCE E AGGREGATE E DEDUCTIBLE RETENTION E E Is B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER/EXECUTNE YIN OFFICERIMEMBER EXCLUDED? (Mandatory in NH) If yes describe under DESCRIPTION OF OPERATIONS below NIA 1803222 01/01/12 01/01/13 X WC STATU- OTH- E.L. EACH ACCIDENT : 100,000 E.L. DISEASE - EA EMPLOYEE E 100,000 E.L. DISEASE -POLICY LIMIT I E 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Real Schedule, It mom space Is required) City of Ft Collins are included as additional insureds by contract. CITY019 City of Ft. Collins Mr O'Neil PO Box 580 Ft. 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. AUTHORMED REPRESENTATIVE ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD