HomeMy WebLinkAbout196580 L & L LANDSCAPE - INSURANCE CERTIFICATE (7)11/01/2012 THU 15:28 FAX 970 674 8826 Renaissance Ins, Group
2001/001
---"1 OP ID: MM
`4� R� CERTIFICATE OF LIABILITY INSURANCE DAT11/01D/2
11l01/12
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(les) must be endorsed. If SUBROGATION IS WAIVED, subject t0
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(st.
PRODUCER Phone:
Renaissance Insurance Group Fax:
P O Box 478
101 E Main Street
INindsor, CO $0550
Jay W. Holzer
INSURED LRD, Inc
DBA L & L Landscape
PO Box 62
Windsor, CO 80550-0062
(yC No. 11M), .. I VVC, No):
E-MAIL
ADDRESS:
PRODUCER LRDINCI
CUsromERIDd:
INSURER(S) AFFORDING COVERAGE_ C.
INSURER A : Allied Insurance Company
INSURER B : Pinnacol Assurance
INSURERC:�-
CAVFRAQFA CFRTIFIAATF MI IMnFR- eFVIQInM NI SAMCM.
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.
LrTR TYPE OF INSURANCE ADDLISUBRI POLICY NUMBER POLICIYEFF POLIO EXP '.. UNITS
GENERAL LIABILITY
EACH OCCURRENCE
$ 11000,00
A
X I COMMERCIAL GENERAL LIABILITY
CLAIMS-MADE X OCCUR
ACPMTC07515036S64
04120/12
04120/13
$ 100.00
AMA t T RENTED
-PREMISES occurrence)
MED_EXP (Anyone person)
$ 10,00
PERSONAL & ADV INJURY
$ 1,000,00
GENERAL AGGREGATE
$ 2.000,00
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS -COMPIOPAGG
S 2,000,00
17 POLICY PRO- ,,, LOC
_._
$
A
AUTOMOBILE LIABILITY
X ANY AUTO
COMBINED SINGLE LIMIT
(Ea zcndenp
',,, BODILY INJURY (Per person)
S SOO,OO
',,. $
ALL OWNED AUTOS
SCHEDULED AUTOS
X HIRED AUTOS
'..,
'.., '.., '....
ACPBA7515036564 '.. 04/20/12 '', 04/20/13
.. BODILY URY
.
$
$
PROPERTY DAMAGDAMACro¢itlent)
E
X NON-OWNEDAUTOS
UMBRELLA LIAR
OCCUR
EACH OCCURRENCE
$ _
AGGREGATE __ _
EXCESS LIAB
CLAIMS -MADE
N/A
$
DEDUCTIBLE
_
$
_
S
RETENTION S
WORKERS COMPENSATION
x WCSTATU- DER
C
AND EMPLOYERS' LIABILITY
ANY PROPRIETORPARTNERIEXECUrVE YIN
OFFICEROAEMBER EXCLUDED?
(Mondomry in NH)
If yes describe under
DES�RIPTIONOFOPERATIONSbelo
NIA
4032158 08/01112 08/01/13
__. TORY LIMITS
EL EACH ACCIDENT
$ 11000,00
$ 1.000.00
-
5 1,000.00
E L DISEASE - EA EMPLOYEE
— -
E. L. DISEASE- POLICY LIMIT
A ',.Leased/Rented
ACPCIM7515036S64 05126(12 04/20/13
Special $5,00
Equipment
Perils $500 ded
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLE$ (Attach ACORO 101, Addmonal ROMAMS Schedule, If mom apace Ia mqulmd)
Fax: 221-6707
rFRTlrlrATF FIAT AFR r-AMr:91 1 ATIAM
CITY OF
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL 6E DELIVERED IN
City of Fort Collins
ACCORDANCE WITH THE POLICY PROVISION$,
PO Box 580
AUTHORIZED REPRESENTATIVE
Fort Collins, CO 80522
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ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD