HomeMy WebLinkAbout515011 AFM TREE SERVICES LLC - INSURANCE CERTIFICATEMar 08 2013 16:37 Skies West Ins Agency Inc 9702233236
page 1
A ORDL CERTIFICATE OF LIABILITY INSURANCE 3/08/20 3
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
SKIES WEST INS AGENCY INC
1531 RIVERSIDE AVE #A
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
FORT COLLINS, CO 80524
INSURERS AFFORDING COVERAGE
INSURED
INSURERA: BURLINGTON INS CO
AF14 TREE SERVICE LLC
INSURERS: PROGRESSIVE
3912 ELMHURST DR
INSURERC: PINNACOL
INSURER D:
FORT COLLINS CO 80526—
INSURER E.
COVERAGES
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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
TYPE OF INSURANCE
POLICYNUMSER
POUCYEFFECTIVE
DATE MNUD
POLICYEXPIRATION
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$ 1 000,000
FIRE DAMAGE (Anyone fire)
$ 100,000
A
® COMMERCIALGENERAL LIABILITY
IIS-00006432
08/01/2012
08/01/2013
MED EXP (Any one person)
$ 5,000
❑ CLAIMS MADE IN-1 OCCUR
PERSONAL B AOV INJURY
$ 1,0001000
❑
❑
GENERALAGGREGATE
$ 2,000rOOO
GENL AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMPIOP AGG
$ 2,000,000
❑ POLICY ❑ PRO-
jECT❑ LOC
AUTOMOBILE
LIABILITY
ANY AUTO
COMBINED SINGLE LIMIT
(Ea Se deN)
$ 1, 000,000
❑
BODILY INJURY
(Per Person)
S
B
❑
®
ALL OWNED AUTOS
SCHEDULED AUTOS
06533966-2
08/04/2012
08/04/2013
❑
BODILY INJURY
(Perwdder)
$
HIRED AUTOS
NON-0WNED AUTOS
❑
PROPERTY DAMAGE
(Per ewiCerY)
$
❑❑
GARAGE LIABILITY
AUTO ON LY - EA ACCIDENT
$
OTHER THAN EA ACC
S
❑ ANYAUTO
$
❑
AUTO ONLY. AGG
EXCESS LIABILITY
EACH OCCURRENCE
$
AGGREGATE
$
OCCUR M CLAIMS MADE
S
$
❑ DEDUCTIBLE
S
❑ RETENTION $
WORKERS COMPENSATION AND
S OTH-
LJ I T VJC RY LIMTATU-I U I
EL EACH ACCIDENT
$ 100, 000
C
EMPLOYERS'LJABILITY
4154641
03/23/2012
04/01/2013
E. L. DISEASE - EA EMPLOYE
$ 100, 000
E L. DISEASE-POUCYLIMIT
$ 500,000
A
OTHER
EQUIFNENT COVERAGE
IIB-00006432
08/01/2012
08/01/2013
1000 DED
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
A WAIVER OF SURROGATION IS INCLUDED ON WORKERS COMP.
ADDITIONAL INSURED FORM CG2010
CERTIFICATE MOI naR I w I Iualocn....... a. I P,TPR- CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
CITY OF FORT COLLINS
GATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 030 DAYS WRITTEN
PURCHASING DEPT
NOTICE TO THE CERTIFICATE HOLDER NAME THE LEFT, BUT FAILURE TO DO 50 SHALL
ATTN: L70EN STEVENS
IMPOSE NO OBLIGATION OR LIABNTYOFA KIND UPON THE INSURER, tTS AGENTS OR
225 N MASON
REPRESENTATIVES.
FORT COLLINS CO 80524—
H REPRESENTA V
(970) 221-6707
ACORD 25S 17197) OACORD C RPORATION 1988