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HomeMy WebLinkAbout106089 WESTERN STATES LAND SERVICES - INSURANCE CERTIFICATE (2)OP ID: JS .44cc>M5. CERTIFICATE OF LIABILITY INSURANCE DAT11116DIVVVV) 1,N6112 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 endorsements . PRODUCER Phone:303-429-3561 Richards, Seeley, & Schaefer, Fax: 303.427-0611 Inc. - 3640 W. 112th Avenue - Westminster, CO 90031 B John Seeley 1 O lb O `lR CONTACT PHONE FAX AIC,�o ESQ; A/C No: — EMAIL .. ADDRESS: PRODUCER WESTE-1 CUSTOMER ID d: INSURERS AFFORDING COVERAGE NAIL N INSURED Western States Land Services 505 N Denver Avenue Loveland, CO 80537 INSURER A: American States Insurance INSURERS: Pinnacol Assurance 41190 INSURER L INSURER 0 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 LTR TYPE OF INSURANCE ADDL POLICY NUMBER MMIDDIYLICYEYYY MMIDDY EXP /YYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Fx-1 OCCUR 02BP85670920 12/15/12 12/15/13 EACH OCCURRENCE $ 1,000,000 DAMA T RENTED PREMISES Ea occurrence E 250,000 MED EXP (Any one person) $ 10,000 PERSONAL& ADV INJURY E 1,000,000 ' GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: POLICY PRO- LOC PRODUCTS - COMP/OP AGG $ 1,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNEDAUTOS 24CC2767412 01130/13 01/30/14 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,00 X BODILY INJURY (Per person) E BODILY INJURY (Per actitlent) E PROPERTY DAMAGE (Per accident) $ X X $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE F OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS be. N I A 1803222 01/01113 01/01/14 X WC STATU- OTH- Y IMIT ER E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYEE1 S 100,000 E.L. DISEASE -POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, N more apace Is required) City of Ft Collins are included as additional insureds by contract. CITY019 City of Ft. Collins Mr O'Neil PO Box 580 Ft. Collins, CO 80522-0580 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE ,DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE �� wFIN L. n © 1988.2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD