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HomeMy WebLinkAbout128847 CRYSTAL LANDSCAPE SUPPLIES INC - INSURANCE CERTIFICATE (5)�1 uP IU: sr
,d►` ouzo CERTIFICATE OF LIABILITY INSURANCE O 111151201 YY)
11/15/2013
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
PRODUCER �MNIR�I
PFS Insurance Group - JT PHONE
4848 Thompson Pkwy, Ste 200 WC No. EMI,
Johnstown, CO 80534 ADDRESS:
EMAIL
Keith Benner PRODUCER ��.....� -
INSURED Crystal Landscape Supplies Inc INSURER A:PInnacolAssurance 41190
6616 N. Garfield Ave. INSUREKa:EMC Insurance Companies 21415
Loveland, CO 80538-1115
INSU"A 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.
WTR
TYPE OF INSURANCE
POLICY NUMBER
MWDD/YLICY YYY
MMIDD�
LIMITS
B
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE Fx] OCCUR
XJ Blkt A] by Agree
4X84863
12/01/2013
12/0112014
EACH OCCURRENCE
S 1,000,00
PREMISES Eaomurrence
S 100,00
MED EXP (Any orw pares))
8 5,00
PERSONAL SADVINJURY
S 1,000,00
GENERAL AGGREGATE
$ 2,000,00
GEML AGGREGATE LMIT APPLIES PER
X POLICY PROIrP.- 71 LOG
PRODUCTS -COMWOP AGG
S 2,000,000
S
B
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON-OWNEDAUTOS
4X84869
12/01/2013
12I01/2014
COMBINED SINGLE LIMIT
(Ea arcide M)
S 1,000, 000
X
BODILY INJURY (Par person)
S
BODILY INJURY (Per scddel
S
PROPERTY DAMAGE
(PER ACCIDENT)
$
X
X
Comp Ded
$ 1,00
Coo Dad
$ 1,00
B
X
UMBRELLA LIAR
EXCESS LIAR
OCCUR
CLAIMS -MADE
4X84863
12101PA13
12(01J2014
EACH OCCURRENCE
$ 1,000,00
AGGREGATE
S 1,000,00
DEDUCTIBLE
I RETENTION 3 10,000
S
X
A
WORKERS COMPENSATION
AND EMPLOYERS' LWBILITY
ANY PROPRIETORMARTNERIEXECUTNE YIN
OFFICERNEMSER EXCLUDED9
(Mandatory In NH)
lee, deacrioe under
DESCRIPTION OF OPERATIONS below
NIA
1312
0WIM13
08/01/2014
X I WC STATU- X I OTH-
E.L. EACH ACCIDENT
3 1,000,0
E.L. DISEASE - EA EMPLOYEE
$ 1,000,00
E.L. DISEASE - POLICY LIMIT
$ 1,000,88
B
Inland Marine
4X84863 12/01/2013
12/01/2014
Leased/Re 25,00
Dad 1,00
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ASech ACORD 101, Addltlonal Remarks Schedule, If more apace 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
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ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD