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HomeMy WebLinkAbout103009 NORTHERN COLORADO CLEANING DBA PORTER INDUS - INSURANCE CERTIFICATEClient#: 14405 PORIN2 ACORD.. CERTIFICATE OF LIABILITY INSURANCE DATE""DNYYY) F 02/01/2013 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 INSURERS), 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 Flood &Peterson Ins., Inc. P. O. Box 578 Greeley, CO 80632 970356-0123 CONTACT NAME: Kelly Beauvais PHONE FAX Arc No Eat : 970 266-7121 ac, No : 970 506-6846 ADDRESS: Kbeauvais@floodpeterson.com CUSTOMER ID C INSURER(S) AFFORDING COVERAGE NAICa INSURED INSURER A: Travelers Insurance Company Northern Colorado Cleaning, LLC d Porter dustries; Maid Clean INSURER B: Pinnacol Assurance 5202Street INSURER C Loveland, CO 80538 INSURER D : 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 TYPE OF INSURANCE DDL UBR POLICY NUMBER CY EFF MFVDO/YYYY POLICY EXP MM/DO/YYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FxI OCCUR 6302B955731 2/05/2013 02105/2014 EACH OCCURRENCE $1 00O OOO DAMAGE TO RENTED PREMISES (Ea occurrence) s3000OO MED EXP (Any one person) $10,000 PERSONAL B ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY x PRD F] LOG PRODUCTS - DOMP/OP AGG s2,000,000 $ A AUTOMOBILE LIABILITY ANY AUTOBODILY ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS P810213955731 2/05/201302/05/201 BINEDISINGLE LIMIT COMBINED s1,000,000 INJURY (Per person) s BODILY INJURY (Per accident) $ 1XX PROPERTY DAMAGE (Per accideNON-OWNEDAUTOS $ $ A X UMBRELLA LIAB CESSLIAB X OCCUR CIAIMSMAOE PSMCUP2B9557 2/05/2013 02/05/201 EACH OCCURRENCE $1 000000 AGGREGATE $1 OOO OOO t DUCTIBLE TENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOP/PARTNEWEXECUTIVEV� OFFICENMEMBER EXCLUDED? (Mandatory in NH) If yes, describe ..der DESCRIPTION OF OPERATIONS Ideas N/A 4153522 7/01/2012 07/01/2013 X I WC STATU- OTH- E.L. EACH ACCIDENT $1000000 E. L. DISEASE -EA EMPLOYEE $1,000,000 E. L. DISEASE -POLICY LIMIT $1000000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space is required) City of Fort Collins is listed as an Additional Insured as their interest may appear as respects General Liability. City of Fort Collins YAC PO Box 580 Fort Collins, CO 80524 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 ACORD 25 (2009/09) 1 Oft #S762332/M762300 01988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD KLB Client#: 14405 17a7a1. f] ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE (mmmD/YYYY) F 02/01/2013 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 Flood & Peterson Ins., Inc. P. O. Box 578 Greeley, CO 80632 970 356.0123 CONTACT NAME: Kelly Beauvais PHONE g70 266-7121 FAX g70 506-6846 A/C No Ex1 : A/C, No ADDRESS: Kbeauvais@floodpeterson.com PRODUCER CUSTOMER ID#: INSURERS) AFFORDING COVERAGE NAIC# INSURED INSURER A: Travelers Insurance Company Northern Colorado Cleaning, LLC dba Porter Industries;Maid Clean 5202 Granite Street INSURER B Pinnacol Assurance : INSURER C: Loveland, CO 80538 INSURER D: 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 LTRTypE OFINSURANCE DDL NSR UBR POLICY NU MBER CY EFF MWDDNYYV POLICY EXP MM/DD/YYYV LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Did OCCUR 6302B955731 2/05/2013 02105/2014 EACHOCCURRENCE $1 DOD ODD DAMAGE TO RENTED PREMISES Eaocmuence $300DOD MED EXP (Any one person) $10,000 PERSONAL &ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PRO LUC PRODUCTS - COMP/OP AGG $2,000,000 $ A AUTOMOBILE LIABILITY ANYAUTO ALL OWNED AUTOSBODILY SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS P8102B955731 2/05/2013 02t0512014 COMBINED SINGLE LIMIT (Es accident) $1 ODDDOO BODILY INJURY (Per person) $ INJURY(Per accident) $ 1XX PROPERTY DAMAGE (Per accident) $ $ A X UMBRELLA LIAR EXCESS LAB X OCCUR -CLAIMS-MADE PSMCUP2B9557 2/05/2013 02/05/201 EACH OCCURRENCE $1 00O O00 AGGREGATE $1000000 DEDUCTIBLE RETENTION $ Is B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOFUPARTNER/EXECUTIVEF—ACH OFFICEWMEMBER EXCLUDED? ❑ (Mandatory in NH) It yes, describe under DESCRIPTION OF OPERATIONS below N/A 4153522 7/D1/2D12 D7/D7/201 X WCSTATU- GTH- E, E.L. ACCIDENT $1,000,000 E.L. DISEASE -EA EMPLOYEE $1,000,000 EL DISEASE -POLICY LIMIT $1,000000 DESCRIPTION OF OPERATIONS / LOCATIONS VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) RE: Carpet Maintenance Certificate holder is included as Additional Insured as required by written contract with respects to liability arising out of work performed by the named insured. City of Fort Collins Attn: James B O'Neill 215 North Mason Street Second Floor PO Box 580 Fort Collins, CO 80522 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 ACORD 25 (2009/09) 1 of 1 #S762333/M762300,,. @ 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD KLB PORIN2 Client#: 14405 ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 02/01/2013 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 Flood &Peterson ins., Inc. P. O. Box 578 CO 80632 970 356-0123 CONTACT NAME: Kelly Beauvais PHONE g70 266-7121 AX 970 506.6846 A/C No EN : A/C, No aDO sn . k6eauvais@floodpeterson.com PRODUCER CUSTOMERIDa: INSURER(S) AFFORDING COVERAGE NAIC N INSURED INSURER A: Travelers Insurance Company Northern Colorado Cleaning, LLC dba Porter Industries;Maid Clean 5202 Granite Street INSURER BPinnacol Assurance INSURER C Loveland, CO 80538 INSURER D: 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 TYPE OF INSURANCE ODL UBR POLICY NUMBER MMIDCD/YYYY MM/DDIYYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CI-MADE1:9 OCCUR 6302B955731 2/05/2013 02/05/201 EACH OCCURRENCE $1 OOO OOO DAMAGE TO T D PREMISES(Eaolccurence $300000 MED EXP(Anyone person) $10,000 PERSONAL B ADV INJURY $1,000,000 GENERAL AGGREGATE 52,000,000 GEN'L AGGREGATE POLICY X LIMITAPPLIES PER: PRO- n LOC PRODUCTS AGO $2,000,000 S A AUTOMOBILE LIABILITY ANYAUTO ALL OWNED AUTOSBODILY SCHEDULED AUTOS HIRED AUTOS AUTOS P8102B955731 2/05/2013 02/05/2014 COMBINED SINGLE LIMIT (Ea accident) $1000000 BODILY INJURY(Per person) $ INJURY(Per accident) $ 1XX PROPERTY DAMAGE (Per eccidenNON-OWNED $ $ A X UMBRELLA LIAB X EXCESS LIAB OCCUR CLAIMS -MADE PSMCUP2B9557 2/05/201302/05/201 EACH OCCURRENCE $1000000 AGGREGATE s1 00O 000 DEDUCTIBLE RETENTION $ S B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOWPARTNEWEXECUTIVEY/N OFFICEWMEMBER EXCLUDED? (Mandatory in NH) It as, describe antler DESCRIPTION OF OPERATIONS below N/A 4153522 7/O1/2012 D7/O1/201 X WCSTAT— OTH - E.L. EACH ACCIDENT $1,000,000 E. L. DISEASEEAEMPLOYEE $1,000,000 E.L. DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) City of Fort Collins Utilities Department 700 Wood Street, Building A Fort Collins, CO 80521-0580 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 ACORD 25 (2009/09) 1 Of 1 #S762344/M762300 ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD KLB