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HomeMy WebLinkAbout109005 POUDRE VALLEY AIR OF NORTHERN COLORADO - INSURANCE CERTIFICATE (2)Client#: 19S28 ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) F D6/14/2012 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 (/ 970 356-0123 0 �) CONTACT NAME: Kelly Beauvais PHONE 970 356-0123 FAX 9705066836 /C No Ert: A/O, No (VC, AL ADDRESS. kelly.beauvais@floodandpelerson.com PRODUCER CUSTOMER ID #: INSURERS) AFFORDING COVERAGE NAIC Y INSURED INSURER A: Travelers Insurance Company Poudre Valley Air of Northern Colorado, Inc 2416 Donella Court, Suite A Fort Collins, CO 80524 INSURER BPinnacol Assurance INSURER C 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 INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHIC CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TE EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE DDL NS UBR POLICY NUMBER POLICY EFF MWOD/YYYY POLICY EXP MWDD/YYYY LIMITS id A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY OCCUR 4TC0862K5833PHX11 10/17/2011 10/17/201 EACH OCCURRENCE DAMA PREMISES OEar occurrence)CLAIMS-MADE MEO EXP(Any one person) PERSONAL& ADV INJURY $,, GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. X POLICY X PRO- n LOO IPr.TA PRODUCTS - COMP/OP AGG $2,000,000 $ AUTOMOBILE LIABILITY ANYAUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON OWNED AUTOS BA862K583311CNS 10/17/2011 10/17/2012 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ X X $ $ A X UMBRELLA LIAB EXCESS LIAR OCCUR CLAIMS -MADE 4TSMCUP862K5833TIL 10/17/2011 10/17/201 EACH OCCURRENCE s3000000 AGGREGATE $3 00O 000 DEDUCTIBLE RETENTION 10000 $ X IS B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVEM OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yas, describe under DESCRIPTION OF OPERATIONS below N/A 4074340 7/01/2012 07/01/201 X WCSTATU- OTH PR EL EACH ACCIDENT $500000 E.L DISEASE - EA EMPLOYEE S500,000 E.L. DISEASE -POLICY LIMIT s500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 1 DU Additional Remarks Schedule, if more space is required) City of Fort Collins Home Efficient Program Y 9ram SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 700 Wood Street PO BOX 580 1 AUTHORIZED REPRESENTATIVE Fort Collins, CO 80522 ©1966-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) 1 Of 1 The ACORD name and logo are registered marks of ACORD #S702605/M702561 SXC