HomeMy WebLinkAboutCUSTOM DISPOSAL - INSURANCE CERTIFICATE04/04/2014 FRI 11:54 FAX
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CUSTO-1 OP ID: MB
.a4C4>R0 CERTIFICATE OF LIABILITY INSURANCE
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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.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must he endorsed. If SUBROGATION IS WAIVED, subject to
the terns 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 endomement(s).
PRODUCER
Renaissance Insurance Group
P O Box 478
101 E Main Street
Windsor, CO 80560
Jay W. Helzer
CONTACT
NAME. �� W. N@12@r
PXONE
(wo, xo Em:970 674 88T5-„__,,,,,_,,..,.,_._ Ne: 970-674-,8826
E•Mai
ADDaEss: 2el2ergrenlDSUrance.Com
INSURER!INSURERM APPOWDING COVERAGE
Nato
INSURER A: Acuity Insurance
14194
_
INsuR.o�, Custom Disposal, LLC
620 East 3rd Street
Eaton, CO 80615
_ _
INSURER B:
INSURER C:
INSURERO:
_
NISURPJLe:
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.
._...... -_
INSA"'"__
LTRTYPE OF INSURANCE POLICY NUMBER--- M mFY MLI NYY LIMITS
A
GENERAL LIABILITY
EACH OCCURRENCE
i 1,000,00
TXCOMMERCIAL
CLAIMS -MADE 1K OCCUR
L67964
0312612014
03126/2016
pR�1@Ey IEaP I
s 250,00
MED_EXP(MY.:Cm)_
W
S 10,00
PERSONAL S ADV INJURY
S 1,000,00
GENL AGGREGATE LIMIT APPLIES PER
GENEPAI AGGREGATE
$ 3,000,00
X POLICY jE�a LOC
PROOUCT8COMPIOP AGO
.___....__.
S 3,000,00
_.__.....___._..
OTHER
S
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
S 1,000,00
A
ANv ALTO
1164
0372612014
0312812016
BODILY INJURY (PM person)
S
-- ALLONMEO HEDUlEO
SCHEDULED
D._Y.....R _..
S
AIL OR
PROPERTYUOAMAGEaw�I
$
HIRED AUTOS AUTOS
I
(PmeWA I _...........
S
OMBRELUL LIPS
OCCUR
EACH OCCURRRNCF
2
AGGREGATE
$
excanim is
CLAIMS -MADE
NIA
RETENTIONS
S
WORKERS COMPENSATION
T Tfw -
--.
AND EMPLOYERS' LIABILITY YIN
E.L. EACH ACCIDENT
$
Mnceem IEYORPAiro.we,E%ECUTIVE
Mrw
NIA
(MaepnCe,d,ddMe�aSryy In NNd))
DISEASE EMPLOYEE
$
6YSGRIPCIIONOFOPERATIONSW.
_E.L. _-EA
E.L. DISEASE -POLICY LIMIT
S
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Addlflpml Remarks Schedule, mey be MMChed if mom sWce le"livil)
Fax: 970-221-6782
CERTIFICATE HOLDER __. CANCELLATION
CITY OF
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Clry of Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS,
215 N Mason St
pnrt CnllinR, C.n Ro599.05ao AUTHORED REPRESENTATIVE
�A4om�M&A?
01988.2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (201"4) The ACORD name and logo am ragistaredmarke, of ACORD