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Home My WebLink About276712 FINE TREE SERVICE - INSURANCE CERTIFICATE (4)Bank of the West 11/30/2012 10:16:12 AM PAGE 1/002 Fax Server DIE50B8875E9ED8 COLORADO- FAX TRANSMITTAL COVER BW INSURANCE .rt AGENCY TO Name City of Fort Collins Company/ Department Voice Phone Fax 919702216707 Phone Date: Friday, November 30, 2012 10:15:50 AM Message: From: Name Matt Diemer Voice 970-267-2226 Phone Fax 86834 Phone Email Matt.Diemer@bankofthewest.com 1075 W Horsetooth Rd. Ste 106 Address Fort Collins CO 80526 Number of pages, including Cover Sheet: 02 This fax is for the personal and exclusive use of the recipient to whom it is addressed. It contains confidential information from the sender. Its contents are to remain absolutely confidential and may also be subject to the attorney -client privilege. If you have received this transmission and are not the intended recipient(s) or his/her agent, please be advised that any disclosure, use, review, copying, selling, dissemination, publication or distribution of this transmission is unauthorized and prohibited. If you have received this transmission in error, please notify the sender immediately by telephone and return the original facsimile to the sender by U.S. Mail. Thank you. Insurance and Investment products are not a deposit or other obligation of, or guaranteed by the bank or its affiliates. Insurance and annuity investments are not insured by the FDIC or any other agency of the U.S., the bank, or any of its affiliates. Insurance and Investment products may lose value. (t 2/05) Bank of the West DIE50B8875E9ED8 11/30/2012 10:16:12 AM PAGE 2/002 Fax Server ACORO® CERTIFICATE OF LIABILITY INSURANCE ��- DATE (MMID ) 11/30/2012012 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 Colorado BW Insurance Agency, Inc. 1075 W Horsetooth Rd, Ste 106 Fort Collins CO 80526 CONTACT Matt Diemer NAME: PHONE IN (970)223-O924 aG No:(9T0)26T-2231 E-MAIL INSURER(S) AFFORDING COVERAGE NAIL0 INSURERA:B arts Ins Co INSURED Fine Tree Service Inc. 3060 Lake Canal Ct Fort Collins CO 80524 INSURERB:Pinnacol Assurance 41190 INSURER C: INSURER D: INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER:2012-2013 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 ADDLSUBR POLICY NUMBER POLICY EFT MM/DD/YYVY POLICY EXP MM/DDNYYV LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO PREMISES (Ea oow rrence) $ 100,000 A CLAIMS -MADE OCCUR 021CP00921 /5/2012 /5/2013 MED EXP(Any one person) $ 5,000 PERSONAL a ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 X POLICY PRO- LOG IFCT $ EOe cNeD S INGLE LIMIT1 OOO OOO BODILY INJURY(Per person) $ AALLOWNED ANVAUTO SCHEDULED AUTOS AUTOSX 021CP00921 /5/2012 /5/2013 POMOBILEUABIUTY BODILY INJURY(Per accltlent) $ DAMAGE Per accident $ NONOWNEDPROPERTY HIRED AUTOS AUTOS Uninsured motorist oombined $ 500,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ B WORKERS COMPENSATION WC STATU- O R AND EMPLOYERS' LIABILITY y / N ANY PROPRIETOR/PARTNER/EXECUTIVE❑ E.L. EACH ACCIDENT $ 100,000 /M OFFICEREMBER EXCLUDED? (Mandatory in NH) IN 4083365 /1/2012 /1/2013 E.L. DISEASE -EA EMLO PYE $ 100,000 Ifyes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Certificate holder is listed as Additional Insured on the General Liability only - as required by written contract. CERTIFICATE HOLDER CANCELLATION (970) 221- 67 07 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 P.O. Box 580 AUTHORIZED REPRESENTATIVE Fort Collins, CO 80522 Brandon Avery/MDFC ACORD 25 (2010/05) INS025/2oloosi o1 01988-2010 ACORD CORPORATION. All rights reserved. This ACnRn damn and Innn ara rnniatnrnd mnrkc of ArG Rn