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HomeMy WebLinkAbout119699 GALLEGOS SANITATION INC - INSURANCE CERTIFICATE (3)From: CCIG Liz Blair To: 19702216782 Page: 2/2 Date: 11 /19/2014 11:28:19 AM GALLE-2 OP ID: LIZ ,�►`oiza CERTIFICATE OF LIABILITY INSURANCE vls/za 1D1111912ol4 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. I - IMPORTANT: It the certificate holder is an ADDITIONAL INSURED, the policy(ies) must De endorsed. If SUBROGATION 15 WAIVED, subject to the teme; 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 endorsements . ' PRODUCER Cherry Creek Ins. Agency, Inc. Phone: 303-799-0110 Suite 500 Fax: 303-799-0156 6660 Greenwood Plaza Blvd. Greenwood Village, CO 80111 Joint Venture - Producers CONTACT Ginn Shaw P oNe FA% : .720-330-7903 IAIc No; 303.799-0156 E-MAIL inn Gthinkcci com ADDRESS: YSC� 9• INSURER(S) AFFORDING COVERAGE NAIC is __ _ _ INSURERA: PInnacol Assurance _ _ 41190 INSURED Gallegos Sanitation Inc 1941 Heath Pkwy Ft Collins, CO 80524 INSURER B: 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. Wall LT TYPE OF INSURANCE ADDLI SUER POLICYNUMBER PO ICYEFF I POLICYEXP LIMITS GENERAL LIABILITY COMMERCIAL GENERAL UAEIUm' CLAIMSMADE 1 IOCCUR EACH OCCURRENCE_ PREMISE Fa �E=u�nence I IMED E%P (Anyena person) PERSONAL & ACV INJURY I GENERAL AGGREGATE PRODUCTS - COMP)OP AGG $ $ Is _ I $ is I GEN'L AGGREIGGATE LIMIT APPLIES PER POLICY PRaJFCT 7LOG is Is AUTOMOBILE LIABILITY ANY AUTO ALLOWNED SCHEDULED _ AUTOS AUTOS NON.OWNED _ HIRED AUTOS AUTOS (Ea accident) L I I BODILY INJURY I LBOORV INJURY (Par amtlenq PROPER7Y'DAMAG! _{Por accident) s 4 $ $ $ UMBRELLA LIAB I EXCESSLIAB OCCUR CLAIMS -MADE j I EACH OCCURRENCE .AGGREGATE $ 8 DED i RETENTION 5 s A WORXERSCOMPENSATION AND EMPLOYERS' LIABILITY MY PROPRIETORIPARTNERIIXECUTNE Y f N OFFICERMEMBER EXCLUOEO? (Menaetory In Nlq If yes, describe under DE SC RI P'DON OF OPERATIONS below NIA 4148231 WC STATI} OTR I X I TOW LIMITS I ER 06/01/2014 06/01/2016 1 E.L. EACH ACCIDENT EL. 010EA3E-EA EMPLOYEE 1 IE.L. DISEASE -POLICY LIMIT i $ 1,000,00 8 1,000,00 I$ 1,000,00 i I I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD tot, Additional Remarks Schedule, If more space Is required) City of Fort Collins 215 North Mason Street PO Box 580 Fort Collins, CO80522-0580 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. thaw ®1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD This fax was sent with GFI FAXmaker fax server. For more information, visit: hftp://www.gfi.com