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Home My WebLink AboutLAUREL HILL CIS INC - INSURANCE CERTIFICATE!'1VVRuN CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DO/YYYY) O1/30/2012 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($). PRODUCER CONTA T NAME: Ewing -Leavitt Insurance Agency PNHO No Est: 970.679.7333 ac Na:866.456.4265 4025 St. Cloud Dr. E-MAIL ADDRESS: Suite 100 Loveland, CO 8O539 PRODUCER 00002465 CUSTOMER ID ii INSURER(S) AFFORDING COVERAGE NAICN INSURED INSURER A: Assurance Company of America 19305 LAUREL HILL GIS INC. INSURERB: Pinnacol Assurance 41190 307 BROSS ST INSURER : Lloyds of London 15792 LONGMONT, CO 80501-5427 INSURER D: INSURER E INSURER F COVERAGES' CERTIFICATE NUMBER: 12/13 pkg 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 INSR SUBR MD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MMIDONYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY DLAIM&MADE IA OCCUR PP503757510802101/2012 02101/2013 EACH OCCURRENCE $ 1,000,00 DAMAGE TO RENTED PREMISES Ea occurrence $ 1,000,000 MED EXP(Any one person) $ 10,00 PERSONAL &ADV INJURY $ GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY JECOT LOC PRODUCTS - COMP/OP AGG $ 2,000,00 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) S BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ 8 A J( UMBRELLA LAB EXCESS LIAR X OCCUR CLAIMS -MADE PPS037575108 02/0112012 02/0112013 EACH OCCURRENCE $ 1,000,00 AGGREGATE $ 1,000,000 DEDUCTIBLE RETENTION $ $ $ B WORKERS COMPENSATION ANDEMPLOYERS'DABILITY YIN OFFICERWEM ER EXCLUDED? ANY ECUTIVE❑ (Mandatary In Ni DESCRIPTION OF OPERATIONS below NIA 40917910410112011 041/11/2012 X WC srATu- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ 1, OOO, OO E.L. DISEASE - EA EMPLOYE $ 1, 000, OO I E.L. DISEASE - POLICY LIMIT $ 1,000,00 C Errors & Omissions USUCS26447201 10/26I201110/26/2012 $1,000,000 Each Claim $2,500 Deductible DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) 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: John Stephens PO BOX 580 Fort Collins, CO 80522 CORPORATION_ All riahfs rnRoi ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD