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HomeMy WebLinkAbout119699 GALLEGOS SANITATION INC - INSURANCE CERTIFICATE (2)GALLE-3 OP ID: AT ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) `—� 05/05/2015 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 certificate holder in lieu of such endorsement(s). PRODUCER CONTANAME: John HintZman _ PFS Insurance Group - JT PHONE FAX 4848 Thompson Pkwy, Ste 200 AIC No Ell: 970-635-9400 A/c No): 970-635-9401 Johnstown, CO 80534 E-MAIL John Hintzman ADDRESS: INSURERS AFFORDING COVERAGE NAIC N INSURER A: Allied Insurance Group_ 19100 INSURED Gallegos Sanitation Inc. INSURER B : GBP, LLC Gallegos Services Colorado LLC INSURER C : Tom Clock INSURERD: P.O. Box 1986 Fort Collins, CO 80522 INSURER E : INSURER F : rOVFRA(,FS CFRTIFICGTF NIIMRFR• RFVI-RIr1N NI IMRFR- 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. INSIR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE ADDL SUB POLICY NUMBER MM DD YYYY MMIDDYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS -MADE OCCUR ACP3007019089 05/01/2015 OS/01/2016 MAGE TO RENTED__ PREMISES Ea occurrence $ 500,00 X MED EXP (Any one person) $ 10,00 Blanket Als X PD Ded $500 PERSONAL & ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 POLICY PRO- JECT 7 LOC PRODUCTS -COMP/OP AGG $ 2,000,00 Emp Ben. $ 1,000,00 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1 000 , ,00 X BODILY INJURY (Per person) $ A ANY AUTO ACP3007019089 05/01/2015 05/01/2016 ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ X X NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Per accident $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,00 AGGREGATE $ 1,000,00 A EXCESS LIAB CLAIMS -MADE ACP3007019089 05/01/2015 05/01/2016 DED X I RETENTION $ 0 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ N/A PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT 1 $ A Equipment Floater ACP3007019089 05/01/2015 05/01/2016 Leased & Rented 50,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) If required by written agreement, the certificate holder is included as additional insured for ongoing operations under general liability. CERTIFICATE HOLDER CANCELLATION CITYOFC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS. Financial Services Risk Management AUTHORIZED REPRESENTATIVE 215 North Mason Street `�, Fort Collins. CO 80524 4 " © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD CI ient#: 1083457 GALLESAN ACORD,, CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 1 5/11/2015 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 certificate holder in lieu of such endorsement(s). PRODUCER USI Colorado, LLC C/L P.O. Box 7050 CONTACT NAME: Maricor Price a/c°ON o EXt : 800 873-8500 a✓c No): 303 831-5295 E-MAIL ADDRESS: den.certificate@usi.biz Englewood, CO 80155 INSURER(S) AFFORDING COVERAGE NAIC # 800 873-8500 INSURER A: Pinnacol Assurance Company 41190 INSURED Gallegos Sanitation, Inc. PO Box 1986 INSURER B INSURER C : Fort Collins, CO 80522 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 CONTRACTOR 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 LTR TYPE OF INSURANCE _ GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR ADDLSUBR INSR WVD NUMBER POLICY EFF MM/DD/Y POLICY EXP MM/DD/YYYY LIMBS ---POLICY $ EEAACCHGOECTCURRENCE PREMISES Ea occur ence $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: 77 POLICY E OT- LOC PRODUCTS - COMP/OP AGG $ $ _ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS COMBINED SINGLE LIMIT Ea accident BODILY INJURY (Per person) _ $ BODILY INJURY (Per accident) $ $ PROPERTY DAMAGE Per accident $ UMBRELLA LIAR EXCESS LIAB H OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? N] (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A 4148231 4/09/2015 06/01 /201 X TO Y LIMIT ERH- E.L. EACH ACCIDENT $1,000,000 - - -- --- -- $1 000 000 E.L. DISEASE - EA EMPLOYEEI E.L. DISEASE - POLICY LIMIT $1 ,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) City of Fort Collins SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Financial Services ACCORDANCE WITH THE POLICY PROVISIONS. Risk Management 215 N. Mason St. 2nd FI;PO Box 580 AUTHORIZED REPRESENTATIVE Fort Collins, CO 80522-0000 @ 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S15073782/M15054995 VSPZP