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HomeMy WebLinkAbout111375 COLORADO LIEN CO - INSURANCE CERTIFICATE (3)AL l.. DAD® `../ CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 1 12/9/2011 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 Black Hills Insurance Agency, Inc. 820 St. Joseph PO Box 3330 Rapid City SD 57709 CONTACT Marilyn Ldr$On NAME: y PH N9. E=U' (605)342-5555 A/C No: (60$)342-7901 ADDAIL RESS,oarilynlarson@bhagency.org PRODUCER 00001170 USTOMER.ID-N: INSURERS AFFORDING COVERAGE NAICR INSURED Colorado Lien Company A Division of Pete Lien 6 Sons, Inc. PG BOX 440 Rapid City SD 57709 INSURERA:Regent Insurance Companv 24449 INSURER B:General Casualty Company of WI 24414 INSURER c: INSURER D: INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER:CL1112905756 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 SUBR W POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY E%P MMIDDIYYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR 2C10219875 1/1/2012 1/l/2013 EACH OCCURRENCE $ 1,000,000 DAMA E TO RENTED PREMISES Ea occurrence $ 300, 000 MED EXP(Any one person) $ 5,000 PERSONALS ADV INJURY $ 1,000,000 GENERAL AGGREGATE It 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRO X l LOC POLICY x l JECT PRODUCTS - COMP/OP AGG $ 2,000,000 $ B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NONOWNED AUTOS CBA0219875 1/1/2012 1/1/2013 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X BODILY INJURY (Per Person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ X X Uninsured motorist combined $ 1,000,000 Underinsured motorist $ 1, 000, 000 B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE CCU0219875 1/1/2012 1/1/2013 EACH OCCURRENCE 8 10, 000,000 AGGREGATE $ 10, 000, 000 DEDUCTIBLE RETENTION $ 10,000 $ X Is A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETONPARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA LCO219875 1/1/2012 1/1/2013 X WC STATU- GTH- TQft E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYEd $ 100,000 E.L. DISEASE -POLICY LIMIT 1 $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) City of Fort Collins is included as additional insured with respect to operations of the named insured as required by contract. CERTIFICATE HOLDER CANCELLATION (970) 221-6586 xFAX 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 Attn: Matt AUTHORIZED REPRESENTATIVE PO BOX 580 Fort Collins„ CO 80522-0580 M Maguire/MARILY`�— ACORD 25 (2009109) ©1988-2009 ACORD CORPORATION. All rights reserved. I NS025 (200909) The ACORD name and logo are registered marks of ACORD