HomeMy WebLinkAbout463826 TATONKA CONTRACTORS LLC - INSURANCE CERTIFICATE (4)Erie
�\ Insurance®
100 Erie Ins. PI. • Erie, PA 16530
CERTIFICATE OF INSURANCE
- THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY -
CERTIFICATE HOLDER COPY
NAME AND NUMBER OF AGENCY
THE DECKER AGENCY INC NN 1 141
37 ELMWOOD AVE
BUFFALO, NY 14201-2018 716-883-1455
NAME AND ADDRESS OF NAMED INSURED
TATONKA CONTRACTORS LLC
C/O JAMES RITZEL
14555 QUAIL RUN RD
HUDSON CO 80642-7718
DATEISSUED 05/02/2015
NAME AND ADDRESS OF CERTIFICATE HOLDER
CITY OF FORT COLLINS
PURCHASING DIVISION
PO BOX 580
FORT COLLINS CO 80522—
This is to certify that policies, as indicated by Policy Number below, are in force for the Named Insured at the time that the certificate is being issued.
AUTOMOBILE LIABILITY
ANY AUTO (OWNED, HIRED,
NON -OWNED)
ADDITIONAL INSURED
Q065630120 1 06/06/2015 1 06/06/2016
EACH OCCURRENCE $
FIRE DAMAGE $
(Any one premises)
MED EXP (Any one person) $
PERSONAL & ADV INJURY $
I GENERAL AGGREGATE 1$ f
DDUCTS-COMP/OP AGG
$
BODILY INJURY
$
(EACH PERSON)
BODILY INJURY
$
(EACH ACCIDENT)
PROPERTY DAMAGE
$
BODILY INJURY AND
g
PROPERTY DAMAGE
1 OOOOOO
COMBINED
EACH OCCURRENCE
AGGREGATE
STATUTORY
BODILY ACCIDENT $ EACH ACCIDENT
INJURY DISEASE $ POLICY LIMIT
BY DISEASE $ EACH EMPLOYEE
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
CANCELLATION: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NO ICE WILL bE
DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
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).
THIS CERTIFICATE IS ISSUED FOR INFORMATION PURPOSES ONLY AND
CONFERS NO RIGHTS ON THE CERTIFICATE HOLDER. IT DOES NOT
AFFIRMATIVELY OR NEGATIVELY LIST, AMEND, EXTEND OR OTHERWISE
ALTER THE TERMS, EXCLUSIONS AND CONDITIONS OF INSURANCE
COVERAGE CONTAINED IN THE POLICY(IES) INDICATED ABOVE. THE TERMS
AND CONDITIONS OF THE POLICY(IES) GOVERN THE INSURANCE COVERAGE
AS APPLIED TO ANY GIVEN SITUATION. LIMITS SHOWN MAY HAVE BEEN
REDUCED BY CLAIMS PAID. THIS CERTIFICATE OF INSURANCE DOES NOT
CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER AND CERTIFICATE HOLDER.
ERIE INSURANCE
SEE REVERSE SIDE
AUTHORIZED Rate
4�1�REPRESENTATIVE
OF-1568 09/12 CIF
COMPLETE NAME AND ADDRESS OF CERTIFICATE HOLDER OR ADDITIONAL INSURED
CITY OF FORT COLLINS
PURCHASING DIVISION
PO BOX 580
FORT COLLINS CO 80522