HomeMy WebLinkAbout121309 FOOTHILLS TREE EXPERTS INC - INSURANCE CERTIFICATE (3)ACORD
CERTIFICATE OF
LIABILITY
INSURANCE
o6io;i2oYY2
PRODUCER (970) 377-0638
Squires Insurance Solutions LLC
4
4025 Automation Way
Bldg B, Suite 4
Fort Collins CO 80525-
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
NAIC#
INSURED
Foothills Tree Experts Inc.
Kevin Walker
3600 Canadian Parkway
Fort Collins CO 80524-
INSURERA. Hartford Fire Insurance
INSURER B. Sentinel Insurance Co Ltd
INSURER C. Pinnacol Assurance
msuRER D:
INSURER E:
COVERAGES
THE R81-I8IT9 OR II49URAI481! LISTI.6 6I•L8W HAVT BEEN I99UI.6 TO THE INSURI.6I4AMI.6 AB81vT ROR THE I48TWITH9TAN151148 ANY
REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,
THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EYCLUSIOMS AND CONDITIONS OF SUCH POLICIES
AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
ADVIL
NERD
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE(MM/DD/YY)
POLICY EXPIRATION
DATE(MM/DD/YY1
LIMITS
*
X
GENERAL LIABILITY
34 UUN QY8384
06/15/2012
06/15/2013
EACH OCCURRENCE
$ 1.000.000
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE Fx_1 OCCUR
/ /
/ /
DAMAGE TO TED
PREMISES He occurrence)
$ 100, 000
MED EXP (Any one person)
$ 5 • 000
PERSONAL B ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER.
PRODUCTS - COMP/OP AGO
$ 2,000,000
POLICY CT LOC
E
/ /
/ /
NOWND
B
X
AUTOMOBILE
LIABILITY
ANY AUTO
34 UUN QY8384
06/15/2012
06/15/2013
COMBINED SINGLE LIMIT
(Ea accident)
$ 1,000,000
X
ALL OWNED AUTOS
SCHEDULED AUTOS
/ /
/ /
BODILY INJURY
(Per person)
$
BODILY INJURY
(Per accident)
$
HIRED AUTOS
NON-OWNEDAUTOS
/ /
/ /
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
/ /
/ /
$
AUTO ONLY. AGO
*
X
EXCESS/UMBRELLA LIABILITY
34 HHU QY8629
06/15/2012
06/15/2013
EACH OCCURRENCE
$ 1,000,000
X OCCUR F_ICILAIMS MADE
AGGREGATE
$ 1,000,000
$
$
/ /
/ /
Is
X RETENTION $10, 000
XI
*
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
4080571
05/01/2012
05/01/2013
X TWO STATU- DTH-
TORY LIMITS ER
E.L. EACH ACCIDENT
$ 500,000
E.L. DISEASE - EA EMPLOYEE$
500,000
OFFICER/MEMBER EXCLUDED?
/ /
/ /
Ifyes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE -POLICY LIMIT
$ 500,000
p
OTHER PROP
34 UGH QY8384
06/15/2012
06/15/2013
BUSER 50,000
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Tree trimming operations. Certificate Holder is listed as Additional Insured on the policy as required by written
contract or permit as per policy forms and conditions.
CERTIFICATE HOLDER CANCELLATION
( ) - (970) 221-6707
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
John Stevens
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT
City of Fort Collins
FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
Forestry Division
INSURER, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
413 South Bryan Ave
Fort Collins CO 80524-
ACORD 25 (2001108)
INS025 (0109).06
in ACORD CORPORATION 1988
Page 1 of 2
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this
certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
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).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing
insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively
amend, extend or alter the coverage afforded by the policies listed thereon.
ACORD 25 (2001108)
I NS025(0108).0e AMS raga 2 of