The URL can be used to link to this page

Home My WebLink About330878 SIMPSON & SIMPSON SALES & SERVICE INC - INSURANCE CERTIFICATEFrom: Rhonda Petsche FaAD: 303-867-2074 Page 1 of 2 Date:8/28/2013 10:19 AM Page:1 of 2 3 &OILSOt� ONL Distinctive Insurance Services Fax To: City of Ft. Collins From: Rhonda Petsche Fax: (970) 221-6707 Pages: 2 Phone: ( ) - Date: 8/28/2013 10:19:05 AM Subject: Simpson & Simpson Sales & Service Phone: (303) 867-2055 Message: As you requested, attached is the certificate of insurance confirming coverages for the captioned insured. Let me know if you need anything else. This fax, including any attachments, is for the sole use of the intended recipient and may contain confidential and privileged information. You are hereby notified that any dissemination, distribution, or duplication of the information contained herein by someone other then the intended recipient is strictly prohibited. If you have received this message in 5655 S. Yosemite Street #101, Greenwood Village CO 80111 Fax: (303) 867-2074 From: Rhonda Petsche FaXID: 303-867-2074 Page 2 of 2 Date:8/28/2013 10:19 AM Page:2 of 2 ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 8/28/2013 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 UUNIAUI NAME: Olson & Olson Ltd GreenwoodS. Yosemite St. #101 GreeVillage CO 80111 (PA Ext:303-867-2055 FAX, No:303-867-2074 ADDRESS:o2 olsonandolson.com INSURER(S) AFFORDING COVERAGE NAIL q INSURER A:Westfield Insurance Company 4112 INSURED SIMPS-1 INSURER B:Pinnacol Assurance INSURERC:Allianz Global Risks US Ins Co 35300 Simpson & Simpson Sales & Service, Inc. Russ Doty PO BOX 524 INSURER D Broomfield CO 80038 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 2071486975 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 ADDLSUBR INSR WVD POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIDDIYYYY LIMITS A GENERAL LIABILITY CVVP5452191 /1/2012 /1/2013 EACH OCCURRENCE $2,000,000 PREMISES Ea occurrence $300,000 X COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR MED FEE (Any one person) $10,000 PERSONAL & ADV INJURY $2,000,000 X XCU Included X Contractual Liab GENERAL AGGREGATE $4,000,000 GENL AGGREGATE LIMIT APPLIES PER PRODUCTS-COMOOPAGO $4,000,000 POLICY X JECT LOC $ A AUTOMOBILE LIABILITY CVVP5452191 /1/2012 71/2013 Ea accident $1,000,000 X BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ DAMAGE Per accident $ NONOWNEDPROPERTY HIRED AUTO AUTOS A X UMBRELLA LIAB X OCCUR CVVP5452191 /1/2012 /1/2013 EACH OCCURRENCE $2,000,000 AGGREGATE $2,000,000 EXCESS LIAB CLAIMS MADE DED X RETENTION$NIL $ B WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN 4095690 /1/2012 /1/2013 X WE STATU- OTH- TORYLIMITS ER ANY OFFICERMEMBER EXCLUDEID?XECUTIVE� NIA EL EACH ACCIDENT $1,000,000 (Mandatory in NH) ELDISEASE-EAEMPLOYEE $1,000,000 If yes describe under DESCRIPTION OF OPERATIONS below FIT .DISEASE -POLICY LIMIT $1,000,000 C BR/lost Floater MZI93022731 /1 /2012 /1/2013 Materials $500,000 Deduct $1,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS VEHICLES (Attach ACORD 101, Additional Remarks Sell if more space is required) All Projects. City of Fort Collins 300 LaPorte Avenue Ft. 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 rese ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD