HomeMy WebLinkAbout398304 LAUREL HILL GIS INC - INSURANCE CERTIFICATE (5)ACORD, CERTIFICATE OF LIABILITY INSURANCE OAT10/14/2013/14/2013
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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.
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).
Ewing -Leavitt Insurance Agency
4025 St. Cloud Dr.
Suite 100
Loveland, CO 30538
INSURED LAUREL HILL CIS INC. 9830, I -
307 BROSS ST
LONGMONT, CO 80501-5427
PN"�"N Et:970.679.7375 ` Na:866.4S6.426S
ADDRESS:
INSURER(S) AFFORDING COVERAGE
NAIC0
INSURER A: Assurance Company of America
1930S
INSURER 8: Pinnacol Assurance
41190
INSURERC: Lloyds of London
SS202
INSURERD:
INSURER E :
INSURER F
COVERAGES CERTIFICATE NUMBER: 13/14 Master E&O Undt 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.
LTR
TYPE OF INSURANCE
INSR
MD
POLICY NUMBER
MMIDD/YYYY
M/DD/YYYY
uM1TS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE ❑X OCCUR
PPS037575108
02/01/2013
02/01/2014
EACHOCCURRENCE
S 1, 000, 00
PREMISES (Ea occurrence)
S 1 000,00
MED EXP (Any one person)
$ 10,00(
PERSONAL IS ADV INJURY
$ Excl.
GENERAL AGGREGATE
$ 2,000,000
GENL AGGREGATE LIMIT APPLIES PER:
X POLICY F7 PRO- LOC
JECT
PRODUCTS-COMP/OP AGG
S 2,000 00
S
A
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
X HIREDAUTOS X NON -OWNED
AUTOS
PPS037575108
02/01/2013
02/01/2014
(Es accident)
$ 1,000,000
BODILY INJURY (Per person)
S
BODILY INJURY (Far accident)
a
Per accident)
$
S
X
UMBRELLALIAB
UM58 LUS
X
OCCUR
CWMS-MADE
PPS03757510
02101/2013
0210112014
EACH OCCURRENCE
3
AGGREGATE
S
DED RETENTION S
S
P000
B
WORKERS COMPENSATION
AND EMPLOYERS' LUIBILITY
� PROPRIIMBER E%C NER( ECUTIV�
(Mandatory in NH)
RO describe under
DESCRIPTION un OPERATIONS below
MIA
409119
04M110113
04M1/2014
X TOW LIMITS ER
E.L. EACH ACCIDENT
S
E.L. DISEASE - EA EMPLOYE
$ 000,00(
S
E.L. DISEASE -POLICY LIMIT
rrors & Omissions
C
UCS2644720131012612013 10126/2014' $1,000,000 Each Incident
$1,000,000 Aggregate
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Mach ACORD 1e1, Additional Remarks Schedule, If more space is required)
GLalalgaCl
City of Fort Collins
Attn: John Stephens
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 Gd`d.' .1
Dustin
ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD