HomeMy WebLinkAbout120528 FORT COLLINS TREE CARE INC - INSURANCE CERTIFICATE (3)ACC)REVCERTIFICATE OF LIABILITY INSURANCE 4/10/20112w'
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
PRODUCER Pat Deaver
First Mainstreet Insurance, LLC PHONNo,6xp: (303)776-5122 FA N.I. 11o1177s-5495
275 S. Main Street, Suite 100 E-MAIL s: pdeaver@firstmainstreet.com
-ADDRPRODUCER 00014108
P.O. BOX 647 _CUSTOMER to N:_
T.Onrnnctnt CO 80502 ` V"� •� INSURERISI AFFORDING COVERAGE NA
INSURED INSURER A -Hartford Fire Insurance Co 19682
INSURER B:Plnnacol Assurance
Fort Collins Tree Care, Inc INSURER C:
301 East Douglas Road INSURER D: _
INSURER E:
Fort Collins CO 60524 INSURER F: ^~
COVERAGES CERTIFICATE NLJMBER-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.
IN S� ADDL SUBRF POLICY EFF POLICY EXP
LT;TYPE OF INSURANCE IIN R�WVD POLICY NUMBER MMIODIYYYY MMIDDIYYVV LIMITS
Af_
GENERAL LIABILITY
r —I
j X I COMMERCIAL GENERAL LIABILITY
-- i—I CLAIMS MADE IXIOCCUR
34NR3900
I
LEACH OCCURRENCE
DAMAGE O TRENTED
-PREMISES _(E... urrence)
one person)
I $ 1,000,000
300, 000
$ 10,000
PERSONAL 8_ADV INJURY
I$
$ 1 , 000,000
GENERAL AGGREGATE
$ 2,000,000
_GEN'L AGGREGATE LIMIT APPLIES PER:
X POLICY PRO r OC
_
PRODUCTS-COMPIOPAGG
$ 2, 000, 000
$
A
4AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
I
'34UUNSR3900
3/5/2012
3/5/2013
COMBINED SINGLE LIMIT
(Ea accident)
1, 000,000
IX
-$
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
X
X
Uninsured motorist BI-single
1 $
Medical payments
Is
IEXCESS
LIAB
LIAR
OCCUR
CLAIMS -MI
EACH OCCURRENCE
$
AGGREGATE -
$"
IHUMBRELLA
y�I
RETENTIONS $
I $
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N
OFFICER/MEMBER EXCLUDED'
(yes, doryin NH)
under
If yes, -DESCRIPTION
DESCRIPTION OF OPERATIONS below
N/A
4148327
9198327
05/01/2012 05/01/2013
5/25/2011 5/1/2012
WC STATU- OTH-I
Y I TORY I- MITS. _L. ER
E.L. EACH ACCIDENT ACCIDENT
$ 100,000
E.L. DISEASE - EA EMPLOYEE$
1QQ, QQQ
E.L. DISEASE - POLICY LIMIT$
5QQ QQQ
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
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
ACORD 25 (2009/09)
Deaver/PAT
1988-2009 ACORD CORPORATION_ All rici re..I
INS025 (2009N) I he ACURD name and logo are registered marks of ACORD