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HomeMy WebLinkAbout106089 WESTERN STATES LAND SERVICES - INSURANCE CERTIFICATE (3)OP ID: ,4�oRo CERTIFICATE OF LIABILITY INSURANCE DATE 01YY) 12104/2013 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 Richards, Seeley, & Schaefer, Inc. 3640 W. 112th Avenue Westminster, CO 80031 B John Seeley INSURED Western States Land Services 505 N Denver Avenue 1060001 Loveland, CO 80537 NAME: PHONE FAx JAle NUJ: _ Na. EMAIL ADDRESS._PRODUCER WESTE-1 C ER I A: INSURE 11AFFORDING COVERAGE MAID# INSURER A: American States Insurance INSURER 0 ; Pinnacol Assurance 41190 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. INSR LTRLIMITSLTS TYPE OF INSURANCE ADDL SUN POLICY NUMBER MWDDrMY MWDD� A OMEtAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS-SWDE O OCCUR 02BP85670950 12/15/2013 12/15/2014 EACH OCCURRENCE f 1,000,00 PREMISES Me occurrences) $ 250,00 MED EXP (Any one Person) - f 10,00 PERSONAL & ADV INJURY S 1,000,00 GENERAL AGGREGATE S 2,000,00 GENT AGGREGATE POLICY LIMIT APPLIES PER: 7 PRO- LOC JECTAUTOMOBILE PRODUCTS -COMPIOP AGO S 1,000,001 S A LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS 24CC2767412 01130/2014 01/30/2015 COMBINED SINGLE LIMIT (Ea ACrJOMI) f 1,000,00 f X BODILY INJURY (Par person) BODILY INJURY (Per eoddeM) S PROPERTY DAMAGE (PER ACCIDENT) S X X S f UMBRELLA LMB EXCESS UAB OCCUR CLAIMS -MADE EACH OCCURRENCE f AGGREGATE f DEDUCTIBLE RETENTION S $ f B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER/ ECUTIVE r—YIN OFFICER/MEMBER EXCLUDED? (Mandarory In NH) I yes. deectlee under DESCRIPTION OF OPERATIONS Below NIA 1503222 01/01/2014 01/01l2015 X WC SfATULIM - OTH- E.L. EACH ACCIDENT f 100,00 E.L. DISEASE - EA EMPLOYEE f 100,000 I E.L. DISEASE- POLICY LIMIT $ 500,0 00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Altach ACORD 101, AddWonal Remake Schedule, If more space Is required) City of Ft Collins are included as additional insureds by contract. CITY019 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ft. Collins THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN tY ACCORDANCE WITH THE POLICY PROVISIONS. Mr O'Neil PO Box 580 AUTHORIZED REPRESENTATIVE Ft. Collins, CO 80522-0580 © 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD