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HomeMy WebLinkAbout104133 FORT COLLINS MONUMENT & STONE - INSURANCE CERTIFICATE (2)CERTIFICATE OF LIABILITY INSURANCE F DATE(MMIDDIYYYY) 08/03/2012 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: Karole Peters Ewing -Leavitt Insurance Agency PHOAX A(CNNo Ext. 970.679.7355 �AfCC,No):866.237.2178 AIL ADDRESS: karole-peters@leavitt.com 4025 St. Cloud Dr. Suite 100 PRODUCER 00005631 C_ U_STOMER ID R: INSURER(S) AFFORDING COVERAGE NAICM Loveland, CO 80538 D INSURED INSURER A: Cincinnati Insurance CO Fort Collins Monument & Stone INSURER B: 824 E. Lincoln Ave INSURER C: Ft Collins, CD 80524 INSURER O: INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 12-13 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 LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MM/OD/YYYY POLICY EXP NMI GD rE YY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 1XI OCCUR X Blkt Addl Insured CPP108408507/24/2012 0712412013 EACH OCCURRENCE $ 1,000,000 DAIVIAGE TO PREMISES Ea occu ante $ S00, DD MED EXP fAny me person) $ 10,00 PERSONAL& ADV INJURY $ 1,000,00 X Blkt Waiver of Sub GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY F7 PRO- LOC JECT PRODUCTS - COMP/OP ADS $ 2,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS CPP108408507/24/2012 07/24/2013 COMBINED OMBI EDl)INGLE LIMIT $ 1,000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ X X $ I$ A X UMBRELLA LIAB EXCESS LIAR Xd OCCUR CLAIMS -MADE CPP1084085 07/24/2012 07/24/2013 EACH OCCURRENCE $ 1,000,00 AGGREGATE $ 1,000,000 DEDUCTIBLE RETENTION $ $ HX $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If as, describe under DESCRIPTION OF OPERATIONS below NIA WC STATUS OTH- TORY LIMITIT E.L. EACH ACCIDENT It E.L. DISEASE- EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT 1 $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Fort Collins Attn: Alyce Carpenter AUTHORIZED REPRESENTATIVE .J P. 0. Box 580 Fort Collins, CO 80522 Karole Peters/KAPETE © 1988.2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD