HomeMy WebLinkAboutCITY OF FORT COLLINS - INSURANCE CERTIFICATE (15)
Insured: This certificate is issued as a matter of information only and confers no
City of Ft. Collins rights upon the certificate holder. This certificate does not affirmatively
215 N Mason St / PO Box 580 or negatively amend, extend or alter the coverage afforded by the
Ft. Collins CO 80522-0580 policy(ies) below. This certificate of insurance does not constitute a
contract between the issuing insurer, 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).
Coverages:
This is to certify that the policy(ies) 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 policy(ies) described
herein is subject to all the terms, exclusions, and conditions of such policy(ies).
Limts shown may have been reduced by paid claims.
Policy Effective Expiration
Type of Insurance: Number Date Date Occurrence Aggregate
Public Entity 5/1/2012 5/1/2013 $3,000,000 $6,000,000
Excess Liability
Liability Coverage.
Retroactive Date: Occurrence Form Policy
Description of Operations/Locations/Vehicles/Special Terms:
CANCELLATION:
Should the above described policy be cancelled before the expiration
500 E 62nd Ave / PO Box 28 date thereof, notice will be delivered according to policy provisions.
Attn:
Email:
Fax:
SELF INSURED RETENTION Authorized Representative:
7/10/2012
Signature Date
including General, Auto, & Error or Omission
Certificate holder is an additional insured with regard to the rental of equipment:
CERTIFICATE OF INSURANCE
Limits
2007 CED CR362L Stock #7200 Serial Number 60475 - Paver
$500,000
STATES SELF-INSURERS RISK RETENTION GROUP, INC.
222South Ninth St Suite 1300
Minneapolis, MN 55402-3332
(612) 766-3000
SEL3017503
Certificate Holder:
Power Equipment Company
Denver, CO 80201
Notice of Cancellation to AI.doc
ENDORSEMENT #23
This endorsement is attached to and becomes a part of policy number SEL3017503.
NOTICE OF CANCELLATION TO DESIGNATED PERSON(S) OR
ORGANIZATION(S) OTHER THAN THE NAMED INSURED
It is understood and agreed that SECTION V – CONDITIONS, paragraph M.
Cancellation, has the following paragraph added:
6. States may cancel or non-renew this policy by mailing or delivering to the
person(s) or organization(s) named in the schedule below, written notice of
cancellation or non-renewal at least:
a. Ten (10) days before the effective date of cancellation if States cancels for
non-payment of premium; or
b. 30 days before the effective date of cancellation or non-renewal if States
cancels or non-renews for any other reason.
States will mail or deliver written notice to the person or organization’s last mailing
address known to States.
Name of Person(s) or Organization(s) and Mailing Address:
Power Equipment Company
500 E 62nd Ave
PO Box 28
Denver, CO 80201
All other terms and conditions remain unchanged.
ENDORSEMEN DATED: July 10, 2012
POLICY PERIOD: May 1, 2012 to May 1, 2013
INSURED: City of Fort Collins, CO
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LEXINGTON INS CO
07/09/2012
Vehicles&Mobi
X
100,000,000
Karen Graham
Suite 200
6399 S. Fiddlers Green Cir
Denver, CO 80201
Vehicle Ded.
USA
Policy Ded.
Arthur J. Gallagher Risk Management Services, Inc.
303-889-2574
X
anibru
05/01/13
303-889-2575
anita_bruner@ajg.com
2007 CED Model CR362L SN: 60475 valued at $259,574
P O Box 580
Power Equipment Company
X
X
City of Fort Collins
RE: Lease/rental of equipment above.
X
X
05/01/12
100,000
A
50,000
500 E. 62nd Avenue
PO Box 28
1-303-773-9999 Anita Bruner
28229324
28229324
X
19437
Greenwood Village, CO 80111
X
Fort Collins, CO 80522
19946731