HomeMy WebLinkAbout495782 ABOVE ALL DENVER WINDOW CLEANING - INSURANCE CERTIFICATE (2)ACORO® VEHICLE OR EQUIPMENT CERTIFICATE OF INSURANCE
DATE(MM/DD/1'YYY)
F
I December 2, 2014
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.
This form is used to report coverages provided to a single specific vehicle or equipment Do not use this form to report liability coverage
provided to multiple vehicles under a single policy. Use ACORD 25 for that purpose.
PRODUCER
CONTACT
NAME:
Angelo Chavez
PHONE 303-954-0509 Fax
A/C No Ert: A/CNo8461
EMAIL
ADDRESS:
Turnpike Dr Ste 205
GN
Westminster, CO 80031
PRODUCERCUSTOMER ID e:
INSURE $ AFFORDING COVERAGE
NAIC C
INSURED
INSURER A;
Timothy Quintana
INSURER B:
4457 Clay St
INSURERC:
Denver, CO 80211
INSURER D:
INSURER E:
DESCRIPTION OF VEHICLE OR EQUIPMENT
YEAR
2005 1
MARE I MANUFACTURER MODEL
Chevrolet Express
BODY TYPE
Van
VEHICLE IDENTIFICATION NUMBER
1GCFG15X351246611
DESCRIPTION
SERIAL NUMBER
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICY(IES) OF INSURANCE LISTED BELOW HAS/HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY
PERIODS) INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT MATH RESPECT TO
WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POUCY(IES) DESCRIBED HEREIN IS/ARE SUBJECT TO
ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POUCY(IES).
INSR
LTR
ADDi
INSRD
TYPE OF INSURANCE
POLICY NUMBER
POLICYEFFECTIVE
DATE(MMIDD/YYYY)
POUCYEXPIRATION
DATE(MMIDDNYYY)
LIMITS
VEHICLE LIABILITY
COMBINED SINGLE LIMIT
$
BODILY INJURY Person)
$ 500,000
BODILY INJURY aoclderd)
$ 500,000
PROPERTYDAMAGE
$ 500,000
GENERAL LIABILITY
OCCURRENCE
CLAIMS MADE
EACH OCCURENCE
$
GENERAL AGGREGATE
$
$
INSR
LTR
Loes
A
TYPE OF INSURANCE
POLICYNUMBER
POLICY EFFECTIVE
DATE(MM/DDNYYY)
POLICY EXPIRATION
DATE(MM DIYYYY)
LIMITS/DEDUCTIBLE
VEH COLLISION LOSS
❑ ACV ❑ AGREED AMT
❑ ❑ STATED AMT
$ LIMIT
$ 250 QED
VEH COMP VEH OTC
❑ ACV ❑ AGREED AMT
❑ ❑ STATED AMT
$ LIMIT
$ 250 DIED
PROPERTY
BASIC BROAD
SPECIAL
❑ ACV ❑ AGREED AMT
❑ RC ❑STATED AMT
❑
$ LIMIT
$ DIED
REMARKS(INCLUDING SPECIAL CONDITIONS I OTHER COVERAGES)(Attach ACORD 101, AddD l Remarb Schedule, If more"" IS r Ired)
ADDITIONAL INTEREST CANCELLATION
Select one of the following:
X The atlditimal interest deacribed below has been added to the policy(tes) listed herein by policy number(s).
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE
A request has been submitted to add the additional interest described below to the policy(ies)
listed heroin by Policynum s
DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
VEHICLE EQUIPMENT INTEREST: LEASED FINANCED
DESCRIPTION OF THE ADDITIONAL INTEREST
ADDITIONAL INSURED LOSS PAYEE
NAME AND ADDRESS OF ADDITIONAL INTEREST
City of Ft. Collins, Purchasing Department
LENDER'S LOSS PAYEE
E
P. O Box 580
LOAN/LEASE NUMBER
Fort Collins, CO 80522
AUTHORIZED REPRESENTATIVE
C 1997.2010 ACORD CORPORATION. All rights reserved.
ACORD 23 (2010/06) The ACORD name and logo are registered marks of ACORD
1004361 142987 09-30-2011