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HomeMy WebLinkAbout111375 COLORADO LIEN COMPANY - INSURANCE CERTIFICATE11i CERTIFICATE OF LIABILITY INSURANCE `� DATE (MMIDD012 l2/le/212 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 Black Hills Insurance Agency, Inc. 820 St. Joseph CONTACT NAME: Marilyn Larson PHO AICNNo,Eal. (605)342-5555 aC No: (605)342-7901 ADDAIL RESS: marilynlarson@bhagency. org PO BOX 3330 PRODUCER .00001170 USTOMERJ INSURERS AFFORDING COVERAGE NAIC# Rapid City SD 57709 INSURED INSURERA:ReCjent Insurance Comnpany 24449 Colorado Lien Company INSURER B:General Casualty Company Of WI 24414 A Division of Pete Lien 6 Sons, Inc. INSURER C: INSURER D PO Box 440 INSURER E Rapid City SD 57709 INSURER F: COVERAGES CERTIFICATE NUMBER:CL12121807099 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 ADD L SUER Wy POLICY NUMBER POLICY EFF MMMDIYYYY POLICY EXP MMIDOIYYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OOCCUR CCI0219875 1/1/2013 1/1/2014 EACH OCCURRENCE D PREMISE: Ea oNcurrence $ 1, 000, 000 $ 300 , 000 MED EXP(Any one person) Is 5,000 PERSONAL B ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PROJECT X LOC PRODUCTS-COMPIOPAGG $ 2,000,000 $ $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS Hired Physical Damage BA0219875 1/1/2013 1/1/2014 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ X X Uninsured motorist combined $ 1,000,000 X Underinsured motorist $ 1, 000,000 $ X UMBRELLA LIAB EXCESS LAB X OCCUR CLAIMS -MADE CCU0219875 1/1/2013 1/1/2014 EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10, 000, 000 DEDUCTIBLE RETENTION Is 10,000 $ X IS A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETORIPARTNER/EXECUTIVE ❑ OFFICERIMEMBER EXCLUDED? (Mandatory in Ni If yes, describe under DESCRIPTION OF OPERATIONS below NIA CWCO219875 1/1 /2013 1/1/2010 X WC $TATD- OTR- E.L. EACH ACCIDENT $ 100 000 E.L. DISEASE - EA EMPLOYEE $ 100,000 E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) City of Fort Collins is included as additional insured with respect to operations of the named insured as required by contract. CERTIFICATE HOLDER CANCELLATION (970) 221-6586 xFAX SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Matt PO BOX 580 AUTHORIZED REPRESENTATIVE Fort Collins„ CO 80522-0580 M Maguire/MARILY"' i �— ACORD 25 (2009109) ©1988-2009 ACORD CORPORATION. All rights reserved. INS025(200909) The ACORD name and logo are registered marks of ACORD