HomeMy WebLinkAbout463826 TATONKA CONTRACTORS LLC - INSURANCE CERTIFICATE3Erie CERTIFICATE OF INSURANCE
InSUranu - THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY -
TOO E,.emc.P1 -Erie. PA 16530 CERTIFICATE HOLDER COPY
NAME AND NUMBER OF AGENCY
THE DECKER AGENCY. INC. NN1141
37 ELMWOOD AVENUE
DATE ISSUED 05/02/201 2
NAME AND ADDRESS OF CERTIFICATE HOLDER
BUFFALO. NY 14101-201B 716-883-1455
NAME AND ADDRESS OF NAM IIN�LS,URED
tE 1D
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CITY OF FORT COLLINS
TATONKA CONTRACTORS LLC
PURCHASING DIVISION
C/O JAMES RITZEL
PO BOX 580
1455 QUAIL RUN RD
FORT COLLINS CO 80522—
HUDSON CO 80642—
This is to certify that policies, as indicated by Policy Number below, are in force for the Named Insured at the time that the certificate is being issued.
AUTOMOBILE LIABILITY Q065630120 106/06/2012 I 06/06/2013
OWNED
EACH OCCURRENCE S
FIRE DAMAGE— S -
(Any one premises)
BED EXP (Any one person) $
PERSONAL & ADV INJURY S
GENERAL AGGREGATE $
Y INJURY
PERSON)
BODILY INJURY AND
PROPERTY DAMAGE
COMBINED
EACH OCCURRENCE
AGGREGATE
STATUTORY
BODILY ACCIDENT $
INJURY DISEASE $
BY DISEASE $
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
EACH ACCIDENT
POLICY LIMIT
EACH EMPLOYEE
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DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
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).
THIS CERTIFICATE IS ISSUED FOR INFORMATION PURPOSES ONLY AND
CONFERS NO RIGHTS ON THE CERTIFICATE HOLDER. IT DOES NOT
AFFIRMATIVELY OR NEGATIVELY LIST, AMEND, EXTEND OR OTHERWISE
ALTER THE TERMS, EXCLUSIONS AND CONDITIONS OF INSURANCE
COVERAGE CONTAINED IN THE POLICY(IES) INDICATED ABOVE. THE TERMS
AND CONDITIONS OF THE POLICY(IES) GOVERN THE INSURANCE COVERAGE
AS APPLIED TO ANY GIVEN SITUATION. LIMITS SHOWN MAY HAVE BEEN
REDUCED BY CLAIMS PAID. THIS CERTIFICATE OF INSURANCE DOES NOT
CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERIS). AUTHORIZED
ERIE INSURANCE
SEE REVERSE SIDE
OF-1568 08111 CIF
AUTHORIZED
REPRESENTATIVE ✓/ ���///