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Home My WebLink About103009 NORTHERN COLORADO CLEANING LLC - INSURANCE CERTIFICATEClient#: 14405 PORIN2 ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DO/YYYY) O6/21/2012 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 CONTACT NAME: Kelly Beauvais Flood & Peterson Ins., Inc. PHONE 970 266-7121 FAX 970 506-6846 HO Ell: 970 X No P. O. Box 578 ADDRESS, kelly.beauvais@floodandpeterson.com Greeley, CO 80632 PRODUCER CUSTOMER ID #: 970 356-0123 Q I INSURER(S) AFFORDING COVERAGE NAIL# INSURED INSURER A: Travelers Insurance Company Northern Colorado Cleaning, LLC Pinnacol Assurance dba Porter Industries INSURER B 5202 Granite Street INSURER C: Loveland, CO 80538 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 CONTRACTOR 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 LILL TYPE OF INSURANCE HEIR dl UBR POLICY NUMBER MM/DDIYYY MM/DD/YVYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR P6302B955731 2/05/2012 02105/2012 EACH OCCURRENCE $1000000 DAMAGE To RETED PREM SES Ea occurrence) $300 000 MED EXP(Any one person) $10,000 PERSONAL &ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PRO LOG PRODUCTS-COMP/OP AGO $2,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON OWNED AUTOS P8102B955731 2/05/2012 02/05/2013 COMBINED SINGLE LIMIT (Ea accitlentl $1,000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ X X $ $ A X UMBRELLA LIAR EXCESS LIAB X OCCUR CLAIMS -MADE PSMCUP213955731 2/05/2012 02105/2013 EACH OCCURRENCE $1000000 AGGREGATE $1 OOO 000 DEDUCTIBLE RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y ANY PROPRIETORJPARTNERIEXECUTIVE r OFFICERIMEMBER EXCLUDED? N N (Mandatory in NH) It yes, describe under DESCRIPTION OF OPERATIONS below N/A 4153522 7/01/2012 07/01/201 X WC STATII- OTH- EL EACH ACCIDENT $1,000000 E. L. DISEASE EA EMPLOYEE $1,000,000 EL.DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) City of Fort Collins Utilities Department 700 Wood Street, Building A Fort Collins, CO 80521-0580 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Tyc...r�1SL_ 01988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) 1 of 1 #S705097/M705055 The ACORD name and logo are registered marks of ACORD NIK