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HomeMy WebLinkAbout128847 CRYSTAL LANDSCAPE SUPPLIES INC - INSURANCE CERTIFICATE (4)UF' ID: JF
,a►coRO CERTIFICATE OF LIABILITY INSURANCE
OS/09I2013
0510912013
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 Phone: 970-635-9400
PFS Insurance Group -JT
4848 Thompson Pkwy, Ste 200 Fax: 970-635-9401
Johnstown, CO 80534
Keith Benner
p �f.
CONTACT
PHONE FAX
WC No Ex): (A/� Noj:
E-DRESS:MAIL
ADPRODUCER
CUSTOMER ID #: CRYST-6
INSURER(S) AFFORDING COVERAGE
NAIL#
INSURED Crystal andscapeSupplies Inc
6616 N. Garfield Ave.
Loveland, CO 80538-1115
INSURER A:Pinnacol Assurance
41190
INSURER B:EMC Insurance Companies
21415
INSURER C
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.
ILTR TYPE OF INSURANCE ADOLISUBRI POLICY NUMBER MMLDDYM/YYEFFMMLicYEXP
DD/1'1'YY LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
B
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE a OCCUR
4X84863
12/01/2012
12/01/2013
DAMAGE TO RENTED
PREMISES (Ea occurrence)
$ 100,000
MED EXP (Any one person)
$ 5,00
PERSONAL SADV INJURY
I $ 1,000,00
X Blkt Al by Agree
GENERAL AGGREGATE
Is 2,000,00
AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGO
($ 2,000,00
��G�EENI
I X 1 POLICY FI PRO n LOC
$
B
AUTOMOBILE
X
LIABILITY
ANY AUTO
4X64863
12/01/2012
12/01/2013
COMBINED SINGLE LIMIT
(Ea accitlenp
$ 1,000,00
BODILY INJURY (Per person)
$
ALL OWNED AUTOS
BODILY INJURY (Per accident)
$
SCHEDULED AUTOS
HIRED AUTOS
PROPERTY DAMAGE
(PeraccidenU
$
X
X
NON -OWNED AUTOS
Comp Ded
$ 1,00
Coll Ded
Is 1,00
X
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$ 1,000,000
AGGREGATE
$ 1,000,000
B
EXCESS LIAR
CLAIMS -MADE
1
4X84863
12/01/2012
12/01/2013
DEDUCTIBLE
$
X
1
$
RETENTION $ 10,000
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETORPARTNERIEXECUTIVE YIN
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
NIA
4041312
06/01/2013
06/01/2014
WC STATU- �r �OTH-
X TORY_LIMITS ^ ER
$ 1,000,000
E.L. EACH ACCIDENT
EL.DISEASE-EAEMPLOYEE
$ 1,000,00
If yes, describe unc
DESCRIPTION OF OPERATIONS ealaw
E.L. DISEASE - POLICY LIMIT 1 $ 1,000,000
B (Inland
Marine
12101120121
12/01/2013
640,664
(4X84863
IEDeudipment
1,000
DESCRIPTION OF OPERATIONS / LOCATIONS VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
If required by written contract or written agreement, the City of Fort
Collins is included as Additional Insured for ongoing operations under
General Liability.
CITYOFC
City of Fort Collins
215 North Mason Street
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
A
01988.2009 ACORD CORPORATION. All rights reserved.
ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD