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HomeMy WebLinkAbout129302 HAGEMAN EARTH CYCLE INC - INSURANCE CERTIFICATE (6)Client#: 24703 HAGEA ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE(MMIO9/16I2013D/YYYY) 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 I NAME: Angie Nissen Flood 8: Peterson Ins., Inc. P. O. Box 578 Greeley, CO 80632 970 356-0123vA I PHONE 970 356-0123 FAX, 970 506-6850 AIC, No, E#: A/CNo: E-MAIL ADDRESS: anissen@floodpeterson.com INSURER(S)AFFORDING COVERAGE NAIC 11 INSURER A: Pinnacol Assurance INSURED IINSURER Hageman Earth Cycle, Inc. 3501 E. Prospect Road B : INSURER C Fort Collins, CO 80525 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 CONTRACTOR 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. LTRR TYPE OF INSURANCE NSRL SUBR W VD POLICY NUMBER MMIDDY� MMIDDY� LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY PREMISESOEa occur ence $ CLAIMS -MADE OCCUR MED EXP(Any one person) $ PERSONAL & ADV INJURY $ GENERALAGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG $ POLICY PROECT LOC $ AUTOMOBILE LIABILITY DMBI NED SINGLE LIMIT EaOaccident BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTYDAMAGE Peraccident $ NON -OWNED HIRED AUTOS AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DEO I I RETENTION$ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERJEXECUTIVIE Y I N OFFICERJMEMBER EXCLUDED? FN� N I A 4036216 1010112013 10/01/201 WCSTATU- OTH- E.L. EACH ACCIDENT $500000 E.L. DISEASE- EA EMPLOYEE ESOO OOO (Mandatory In NH) If yes, tlescribe under DE SCRWTION OF OPERATIONSbeew - - EL DISEASE -POLICY LIMIT E500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) Updated Workers' Compensation Coverage Re: Snow Removal City of Fort Collins Purchasing Department 215 N Mason PO BOX 580 Fort Collins, CO 80522 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2010/05) 1 of 1 #S826829IM826821 @ 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD rIIYYY Client#: 24703 HAGEA ACORDTa CERTIFICATE OF LIABILITY INSURANCE D 9/16/2IDDIYYYV) 1/16/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement($). PRODUCER ONTACT Angie Nissen CAME Flood 8 Peterson Ins., Inc. a/CDNe Est): 970 356-0123 IC, No), 970 506-6850 P. O. Box 578 E-MAIL anifld eterson.com ADDRESS: ssenooPINSURER(S) Greeley, CO 80632 AFFORDING COVERAGE NAIC# 970 356-0123 INSURER A: Pinnacol Assurance INSURED INSURER B Hageman Earth Cycle, Inc. 3501 E. Prospect Road INSURER C Fort Collins, CO 80525 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 CONTRACTOR 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 BRI NSR ADDLIWVDI POLICY NUMBER MM/DDY� MMIDDYIYYYY LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F-IOCCUR EACH OCCCURRENCE $ PREMISES 6a oNcur ence $ MED EXP(Any one person) $ PERSONAL B ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRO- POLICY 7 JECT LOC PRODUCTS - COMP/OP AGO $ $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS COMBINED SINGLE LIMIT Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTYDAMAGE Per duct tlent $ UMBRELLA LIAB EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION$ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETOR/PARTNEWEXECUTIVE OFFICER/MEMBER EXCLUDED? � (Mandatory In NH) describe under If DESCRIPTION OF OPERATIONS below NIA 4036218 10/01/2013 10/011201 WCSTATU- OTH- To YMIT R E.L. EACH ACCIDENT $SOO,000 E.L. DISEASE -EA EMPLOYEE s500,000 EL DISEASE- POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Updated Workers' Compensation Coverage City of Fort Collins Risk Management Dept. Attn: Darlene P.O. BOX 580 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 ACORD 25 (2010105) 1 of 1 #S826843/M826821 ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AXN