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Home My WebLink AboutGRAFFITTI'S INC DBA MIKE'S HAULING & CLEANUP SERVI - INSURANCE CERTIFICATEFrom: Lisa Prewih At: Brown 8 Brown Insurance FaxID: (970) 484-4165 To: Sates Tax Divison Date: 121202011 03:12 PM Page: 2 of 2 �RoCERTIFICATE OF LIABILITY INSURANCE OPID LD DATE(MM 1z/2/11® 0111) 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($), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: It the certificate holder is an ADDITIONAL INSURED, the po Icy les must be endorsed. G O , subject to the terms and condltlons of the policy, certaln policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAMEPHONE (AIC, NE, Extl: (AIO, No): Brown 6 BIown Inc 9532 Boardwalk Dr, Suite 200 E ADDRESS CUSTOMER GRAFF-1 Fort Collins CO 80525 Phone:970-482-7747 Fax:970-484-4165 INSURER($) AFFORDING COVERAGE NNCA INSURED INSURER A: Pinnacol Assurance Company 41190 Graffitti's Inc. dba: Mike's Hauling 6 Cieanup Service INSURER B: Mountain States Mutual 14648 INSURER C: PO Box 7634 Loveland CO 80537-0634 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. NOTWITH STANDING ANY REOUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO MICH THIS CERTIFICATE MAYBE 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. LT R TYPE OF INSURANCE INSR WOD POLICY NUMBER (MMIDDRYYY) (MMIDDNYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $1,000,000 PREMISES (Ea omwence) $100,000 B X COMMERCIALGENERALDABIL ITY CGLO132837 12/01/11 12/01/12 CLAIMS -MADE ❑X OCCUR MED EXP(Any one person) $10,000 PERSONAL B ADV INJURY $1,000,000 GENERALAGGREGATE $2, 000, 000 SENT AGGREGATE LIMIT APPLIES PER. PRODUCTS-COMP/OPAGG sIncluded POLICY M PRO -CT LOG $ AUTOMOBILE LIABILITY COMBINEDSINGLEGLELMR (Ea eeenq $1,000,000 B ANY AUTO BAP0132837 12/01/11 12/01/12 BODILY INJURY(Perperson) $ ALL OWNED AUTOS BODIL YINJJ R Y(Prr x.dete) $ X SCHEDULED AUTOS HIREDAUTOS PROPERTY DAMAGE (Per ecc4ent) $ NON -OWNED AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMSMADE AGGREGATE $ DEDUCTIBLE $ $ RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YINrvr OFFICERM,E BER EXCLUDED?MY ECUT� IA 4007823 01/01/11 01/01/12 X - - TORY LIMITB ER ELEACH AC'TACIDENT $500,000 EL. DISEASE EA EMPLOYEE $500, 000 (Mandatory In NHl Il We describe inner DESCRIPTION OFOPERATIONS E0. E.L. DISEASEPOLICYLIMIT I $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (AtlacK ACORD 101, Addttlonal Ramarke SCNedule, Ir more apace Ie required) Garbage, Ash or Refuse Collecting 221-6782 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITYFTS THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Fort Collins Purchasing Sales Tax Division 281 N College Avenue Fort Collins CO 80522 All rinhrc rwcurvnd ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD rrom: Kena Benson At: brown a brown oT Uoloraao Inc. raXl u: ly iu/ 4a4-41oo I o: ury, or rorT Downs ii lLnquiJi I Ua:9R AM rage: ) OT Z �Fb® CERTIFICATE OF LIABILITY INSURANCE OP ID DA DATE(MMIDDYVYVJ 12 13 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 endorsement(s). PRODUCER NAME: Brown il< Brown Inc PRONE NC, No, E.U: (AIC, No(: ADDRESS: 4532 Boardwalk Dr, Suite 200 Fort Collins CO 80525 -PRODUCER _------------'--- CUSTOMERIDN: GRAFF-1 Phone:970-482-7747 Fax:970-484-4165 INSURER(S) AFFORDING COVERAGE NAICX INSURED Graffitti's Inc. Service dba: Mike's Hauling 6 Cleanup INSURER A: Pinnacol Assurance Compan 41190 -- INSURER Mountain States Mutual INSURER C: .1464.8 PO BOX 7634 Loveland CO 80537-0639 - - INSURER D: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS 10 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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. INSA011C TYPE OF INSURANCE INSR WVD POLICY NUMBER (MMIDDIYYYY) (MMIDD/1YYV) l LIMITS GENERAL LIABILITY EACH OCCURRENCE S 1, 000, DOG B __.. X COMMERCIAL GENERAL LIABILITY _ _ .. .. I CLAIMS -MADE X OCCUR CGLO132837 12/01/11 12/D1/12 'UAN GElSTRENTEU— PREMISES Ea occurrence( ... MED EXP(Anyone person) - .$,1.00,000 ............ .._ $10,000 PERSONAL A ADV INJURY $ 1, 000, 000 GENERAL AGGREGATE s2,000,000 PRODUCTS-COMPIOP AGG $Included GENT AGGREGATE LIMIT APPLIES PER: PRO POLICY I JECT El LOC _..__......_..__ _ __ $ AUTOMOBILE LIABILITY COMBINEOSINGLE LIMIT (Ea acclden0 $ 1,000, 000 B ANY AUTO BAP0132837 12/02/11 12/01/12 --- BODILYINJURY(Perperson) ------- $ _ . ,,.._ ALL OWNED AUTOS I --""-"'- BODILY INJURY (Per accident) $ X SCHEDULED AUTOS HIREOAUTOS I PROPERLY DAMAGE (Per accident) $ NON -OWNED AUTOS I $ I $ UMBRELLA LIPS OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LUB CLAIMS -MADE 1 DEDUCTIBLE b $ RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNFR/EXECUTIV OFFICERIMEMBER EXC.LO➢ED4 IA 007B23 01/01/11 Ol/Ol/12 I ' X L U- TORV LIMITS ER E.L. EACH ACCIDENT $500,000 E.L. DISEASE - EA EMPLOYEE ----..._._.__ E.L. DISEASE -POLICY LIMIT _._-- $ 500,000 —_.._.....--._.._.... s500,000 (Mandatory inNR) 11 yes, describe under DESCRIPTION OF OPERATIONS below 'll DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more space is required) Garbage, Ash or Refuse Collecting CERTIFICATE HOLDER CANCELLATION C ITYFTS I 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 AUTHORIZED REPRESENTATIVE Purchasing 281 N College Avenue All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD 11o11,. rtena ucnsvn nr. Duch a DIO%n DI wmlauv inu. rax,v. Iorul vvv-v rvv I u. wy m rm r wunn mare. a w,�u I I uv. vv rave rage. z m c J:E�?Fb® CERTIFICATE OF LIABILITY INSURANCE OP ID DA DATE(MM/DDIYYYY) 12/13 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 IN5URER(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 NAME: Brown & Brown Inc PHONEFAX A/C,NV Ext: (A/C,Nv): ADDRESS: 4532 Boardwalk Dr, Suite 200 Fort Collins CO 80525 cusroMER ID a: GRAFF-1 Phone:970-482-7747 Fax:970-484-4165 INSURER(S) AFFORDING COVERAGE NAIC0 INSURED INSURERA: Pinnacol Assurance Company 41190 Graffittils Inc. dba: Mike's Hauling 6 Cieanup Service INSURER B: Mountain States Mutual 14648 ------- --------.---....- INSURER C: PO Box 7634 Loveland CO 80537-0634 -- ------------- NSURERD: 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, PERM 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. LTR TYPE OF INSURANCE AB----'-' INS R WVD POLICY NUMBER -POLICVEFF (MM/DD/YYYY) PDLlCY1FXP-r (MMAID/YYYY) - LIMITS B GENERAL LIABILITY X COMMERCIAL GENERALLIABILITY CLAIMS -MADE " 1 OCCUR CGLO132837 12/01/11 12/01/12 EACH OCCURRENCE $ 1,000,000 PREEMSE (aoccuTEOirence) $ 100,000 ME'Q E%P (Any one person) $ 10,000 PERSONALS ACV INJURY $ 1,000,000 GENERAL AGGREGATE PRODUCTS - COMP/OP AGG S 2,000,000 $ Included GENT AGGREGATE LIMIT APPLIES PER: POLICY PRO- JECT LOC $ B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULEDAUTOS HIRED AUTOS NON -OWNED AUTOS BAP0132837 I I I 12/02/11 12/01/12 COMBINED SINGLE LIMIT (Ea accident) -------'-- $1, 000,000 — - BODILY INJURY IPC. p....r) ...---- ---- $ -- ------ BODILY INJURY (Per accident) $ X -- --- PROPERTYDAMAGE IPcr actldenl) $ $ UMBRELLA LIAR OCCUR EXCESS LIAR CLAIMi DEDUCTIBLE RETENTION E j EACH OCCURRENCE $ AGGREGATE $ $ S A WORKERS COMPENSATION YIN ANY PROPRIETOR/PARTNER/EXECUi �y' OFFICER/MEMBER E%CLUDED? u (Mandatory in NH) II yes. describe under DESCRIPTION OF OPERATIONS below /A 4007823 01/01/11 O1/01/12 X TORYL HITSAND IT ER__ E.I. EACH ACCIDENT $500,000 ------- E.L. DISEASE - EA EMPLOYEE ------ - $ 5 0 0 , 0 0 0 E.I. DISEASE - POLICY LIMIT ---- ----- $500, 000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule. if more space is required) Garbage, Ash or Refuse Collecting CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITYFT7 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Fort Collins AUTHORIZED REPRESENTATIVE Building rr Zoning 281 N College ---L —�� , I , ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD