HomeMy WebLinkAboutNORTHERN COLORADO CLEANING LLC DBA PORTER IND - INSURANCE CERTIFICATEClient#: 14405
NCCLE
ACORD. CERTIFICATE OF LIABILITY INSURANCE
F DATE""'
D2107/2012
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(s).
PRODUCER
Flood & Peterson Ins., Inc.
P. O. Box 578
Greeley, CO 80632
970356-0123
CONTACT NAME: Kelly Beauvais
PHONENo A
A/C EXt : 970 266-7121 A/C, No): 970 506-6846
E-MAIL Kelly.Beauvais@floodandpeterson.com
ER
CUSTOMER ID C
INSURER(S) AFFORDING COVERAGE
NAIL#
INSURED
INSURER A: Travelers Insurance Company
Northern Colorado Cleaning, LLC
dba Porter Industries, Inc.
5202 Granite Street
INSURERS: Pinnacol Assurance
INSURER C
Loveland, CO 80538
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.
INSLTR
OF INSURANCE
UDDLTYPE
§1L
U9R
POLICY NUMBER
MM/OD/YYYY
MWOD/YYYY
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE a OCCUR
63028955731
2/05/2012
02/05/2013
EACH OCCURRENCE
$1 ODD 000
PREMISES (Eaoccurrence)
s3000OO
MED EXP (Anyone person)
$10,000
PERSONAL& ADV INJURY
$1,000,000
GENERAL AGGREGATE
$2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
X POLICY X PRO JECT LOC
PRODUCTS-COMP/OP AGG
$2,000,000
$
A
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOSBODILY
SCHEDULED AUTOSPROPERTY
AUTOS
NON -OWNED AUTOS
8102B955731
2/05/2012
02105/2012
COMBINED AEI' SINGLE LIMIT
(Ea
$1,000,000
BODILY INJURY(Per person)
$
INJURY (Per accident)
$
1XX
DAMAGEHIRED
(Per accidenl)
$
A
X
UMBRELLA LIAB
EXCESS LIAB
X
OCC
OLAIMSUR -MADE
CUP2B955731
2/05/2012
02/05/201
EACH OCCURRENCE
$1 000 000
AGGREGATE
$1,000,000
RETENTION $ 10000
$
HDEDUCTIBLE
X
1
$
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOWPARTNER/EXECUTIVEY
OFFICERIMEMBER EXCLUDED?
(Mandatory In NH)
If yes. descnos under
DESCRIPTION OF OPERATIONS below
N/A
4153522
2/05/2012
07/0112012
X WC STATU- OTH-
E.L. EACH ACCIDENT
$1000,000
E.L. DISEASE - EA EMPLOYEE
$1,000,000
E.L. DISEASE -POLICY LIMIT
$1,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ANach ACORD 101, Additional Remarks Schedule, B more space, is required)
City of Fort Collins SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Utilities Department ACCORDANCE WITH THE POLICY PROVISIONS.
700 Wood Street, Building A
Fort Collins, CO 80521-0580 AUTHORIZED REPRESENTATIVE
01988-2009 ACORD CORPORATION. All rights reserved.
ACORD 25 (2009/09) 1 of 1 The ACORD name and logo are registered marks of ACORD
#S675097/M675056 _ _. _ KLB