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HomeMy WebLinkAboutLAMAR VALLEY CRAFTSMAN LLC - INSURANCE CERTIFICATE2/1/2012 11:52 AM FROM: JCB TO: 2216775 PAGE: 001 OF 002 c o n f ax To: CITY FT C Fax Number: 2216775 From: Linda Decker Fax Number: 970-484-2885 Business Phone: 970-484-2805 Home Phone: Pages: 2 Date,Mme: 2/1/2012 11:52:29 AM Subject: 2/1/2012 11:52 AM FROM: JCB TO: 2216775 PAGE: 002 OF 002 ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE (MMDDI12 oz/o1/zolz 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 CONTACT MANE: Linda Decker JOHN C. BECKETT & ASSOCIATES, INC. PHONE o, EMI: (970) 484-2805 202 (FAA/0 NO): (990) 989-2885 nooaess: Linda@beckettinsurance. com 220 Smith Street PRODUCER Lamar Valle Craftsman, LLC CUSTOMER ID p. Y Ft. Collins CO 80524— INSURER(S) AFFORDING COVERAGE NAIC# INSURED INSURER A :WESTERN HERITAGE INSURANCE CO Lamar Valley Craftsman, LLC INSURER B 415 Mason Ct. 10-A INSURER C INSURER D INSURER E Fort Collins CO 80524— 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. INSB LTR TYPE OF INSURANCE POOL INSB SUBB WVD POLICY NUMBER POLICY EFF (MNDD/YTTT) POLICY E%P (MNDD/YTTT) LIMBS A GENERAL LIABILITY SCP0871782 1/31/2012 1/31/2013 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY / / / / DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 CLAIMS -MADE 1XI OCCUR / / / / MED FAR (Any one person) $ 1,000 PERSONAL & ADS INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER'. / / / / PRODUCTS - COMP/OPAGO $ 2,000,000 X POLICY PRO LOC JECT / / / / NOWND $ AUTOMOBILE LIABILITY AN ALL OWNED AUTOS OBANE SCHEDULED AUTOS HIRED AUTOS 0 COVERAGE / / / / / / / / / / / / COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Peracadent) $ NON -OWNED AUTOS / / / / $ UMBRELLA LIPS OCCUR 0 COVERAGE / / / / EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE / / / / AGGREGATE $ / / / / DEDUCTIBLE $ RETENTION $ / / / / $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOPPARTNER/EXECUTIVE 90 COVERAGE / / / / WC STATU- OTH- TORV LIMITS ER E.L.EACH ACCIDENT $ OFFICEWMEMBER EXCLUDED' F-1 (Mandatory in NH) N/A / / / / E. L. DISEASE - EA EMPLOYEE $ If yes describe under DESCRIPTION OF OPERATIONS below / / / / ELDISEASE- POLICY LIMIT $ 0 COVERAGE DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, R more space Is required!) CERTIFICATE HOLDER CANCELLATION ( ) — (970) 221-6775 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 BUILDING AND PLANNING AUTHORIZED REPRESENTATIVE PO BOX 580 FORT COLLINS CO 80522-0580 {nam Ir.'` " ACORD 25 (2009/09) © 1988-2009 ACORD CORPORATION. All rights reserved. INS025 (200909) The ACORD name and logo are registered marks of ACORD