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Home My WebLink About475754 DANCZAK RESOURCES INC - INSURANCE CERTIFICATEClient#: 41364 DANRE ACORD: CERTIFICATE OF LIABILITY INSURANCE DATE(MwDGIYYYI') 06/19/2012 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 pollcy(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 CONTACT NAME: Rosemary Kisling Flood & Peterson Ins., Inc. PHONE 970-506-3233 970-330-1867 AIC No EH : A/C, No P. O. Box 578 ADDRESS: rosemary.kisling®floodandpeterson.com Greeley, CO 80632 970 356-0123 CUSTOMER ID INSURER(s)AFFORDING COVERAGE NAICs INSURED INSURER A: United Fire & Cas. ' Danczak Resources, Inc. P.O. Box 339 INSURER B: Johnstown, CO 80534 INSURERC: NSUPER 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. INSR LUL TYPE OF INSURANCE POLICY NUMBER MM/DU/YFF MMUDD/VYPtOCCURRENCE LIMBS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 51OCCUR X PD Ded:250 60080110 7/18/2012 07/18/201RENCE $1 000000 pccudexe $10D000 one person) S5,000 ADV INJURY $1,DD6D00 GREGATE $2,000 O00 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO LOC COMP/OP AGO g2,000000 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS 60080110 7/18/2012 07/18/2013 COMBINED SINGLE LIMIT (Eaeccitlani) $100D000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) S 1XX PROPERTY DAMAGE (Per accident)S $ $ UMBRELLA LIAR EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ S WORKERS COMPENSATION ANDEMPLOYERTUABILIY Y/N ANY PROPRIETORIPARTNE1I ECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) It yes. deemibe under DESCRIPTION OF OPERATIONS We w WA WG gTATU OTH- E.L EACH ACCIDENT g E.L DISEASE EA EMPLOYEE $ ELDISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS / LOCATIONS/ VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required!) Certificate holder is included as Additional Insured as required by written contract with respects to liability arising out of work performed by the named insured. City of Fort Collins Purchasing 215 N Mason 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 01988.2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) 1 of 1 #S703521/M703516 The ACORD name and logo are registered marks of ACORD PXP Client#: 41364 DANRE ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MWDWYYYY) D6/19/2012 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(les) 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 CONTACT NAME: Rosemary Kisling aL4NN E�:970-506-3233 FA uc No: 970-330-1867 ADDRESS: rosemary.kisling@floodandpeterson.com CUSTOMER 10 a: INSURER(S) AFFORDING COVERAGE NAIC a INSURED Danczak Resources, Inc. P.O. Box 339 INSURER A: United Fire & Cas. INSURER 8: Johnstown, CO 80534 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 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. LUL TYPE OF INSURANCEalL POLICY NUMBER MWDD/YYY MMIDDNYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABWTY CLAIMS -MADE [:� OCCUR X PDDed:250 60080110 7/18/2012 07/18/2013 EACH OCCURRENCE $1 000 000 PREMISES Ea occurrence $100000 MED EXP (Any one person) $5 DOD PERSONAL BADVINJURY $1,000,000 GENERAL AGGREGATE $2,000000 GENL AGGREGATE OMIT APPLIES PER: POLICY PRO- LOC PRODUCTS - COMP/OP ADS s2,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS 60080110 7/18/2012 07/18/201 COMBINED SINGLE LIMIT (Ea accitlenQ $100D000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ 1XX PROPERTY DAMAGE (Per accident)$ S $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ WORKERS COMPENSATION ANDEMPLOYERS'UABILITY YIN ANY PROPRIETOWPARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) if yes. describe under DESCRIPTION OF OPERATIONS below WA WC STATU- OTN- EL EACH ACCIDENT $ E.L DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS LOCATIONS VEHICLES (Attach ACORD 101. AddlUonal Remarks Schedule, a more space Is required) Re: Snow Removal - Attn: John Stevens City of Fort Collins, its officers, agents and employees are named as (See Attached Descriptions) City of Fort Collins I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE P O Box 580 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Fort Collins, CO 80522 ACCORDANCE WITH THE POLICY PROVISIONS. ®1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) 1 of 2 The ACORD name and logo are registered marks of ACORD - #S703520/M703516 PXP