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HomeMy WebLinkAbout120528 FORT COLLINS TREE CARE INC - INSURANCE CERTIFICATE (2)ACC)Rb® GATE (MNJ00/Y CERTIFICATE OF LIABILITY INSURANCE 1 2/26 /2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS li 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). CONTACT PRODUCER _ _. _. _ __..— _._ __. ___._._ NAME:. Pat Deaver - First Mainstreet Insurance, LLC PHONE ,E><0; (303)776-5122•,... _ __ .. �aC\N1303)776-5495__ EMAIL - 275-Main-Main Street, -Suite i100 _Apoaess:_Pdeaver@£irstmaiKi treet.6om"'_- _ - - ----- PRODUCER 0001410E ` P.O. BOX 847 .. _ CUSTOMER ION:_- Lonamont CO 80502 INSURER(S) AFFORD INOCOVERAGE NAICN INSURED \ U INSURER A:Hartt Ord Yire insurance CO 'i `J b B2 70 INSURER B:Pinnacol Assurance Fort Collins Tree Care, Inc INSURER C: 301 East Douglas Road INSURER D: INSURER E : Fort Collins CO 80524 INSURER F: rnvmmer_cc rFRTIFIr.ATF NI IMPtFR•12-13 GL AL 11-12 WC 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. LEF TIR TYPE OF INSURANCE AINSRI WVD POLICY NUMBER MM DI DY/YYYY MM/OD,YYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES (Ea occurrence) $ 300, 000 A CLAIMS -MADE OCCUR '34UUNSR3900 '3/5/2012 3/5/2013 MED EXP(Any we person) $ 10,000 PERSONAL B ADV INJURY $ - —1,000,000 GENERAL AGGREGATE- - $ �2,000,000 - - - .: .. r. �' . ,., �. - - ,.. -- _ GEN'L AGGREGATE LIMIT APPLIES PER'. .. .. PRODUCTS-COMPIOP. AGG $ ... 2.,000,000 .. PRO- I� X POLICY �7 LOC AUTOMOBILE LIABILITY, - COMBINED SINGLE LIMIT (Ea accitlenq X BODILY INJURY (Per person) ' -'. $ A ANY AUTO ALL OWNED AUTOS '34UUNSP-3900 '3/5/2012 3/5/2013 BODILY INJURY (Per accident) PROPERTY DAMAGE (Per battlers) $ SCHEDULED AUTOS HIRED AUTOS X Uninsured motorist BI-single Is X NON -OWNED AUTOS Medicbl payments Is UMBRELLA LAB OCCUR I EACH OCCURRENCE 1 $ EXCESS LIAB CLAIMS -MADE) AGGREGATE Is DEDUCTIBLE,,s¢,, DEDUCTIBLE RETENTION $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE Y� WC STATU- OTH- y TORY-LIMITS�� ER EL EACH ACCIDENT s 100,000 OFFICERIMEMBER EXCLUDED? (Mandatory in NH) NIA q 14e327 5/25/2011 /1/2012 E.L. DISEASE - EA EMPLOYE s 100,000 E.L. DISEASE -POLICY LIMIT $ 500,000 If yes describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS VEHICLES (Attach ACORD 101. Additional Rabbi Schedule, if more space is re9uired) City of Fort Collins as Additional Insured as required by written contract per General Liability policy form. (970)221-6707 City of Fort Collins Purchasing Division P O Box 580 Fort Collins, CO 80522 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Deaver/PAT ACORD 25 (2009109) ©1988-2009 ACORD CORPORATION. All rights reserved. INS025 (2D09o9) The ACORD name and logo are registered marks of ACORD