HomeMy WebLinkAbout129302 HAGEMAN EARTH CYCLE INC - INSURANCE CERTIFICATE (7)CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/V)
osn7/2018zo18
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 have ADDITIONAL INSURED provisions or 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
CONTACT Brianne Danielson, CISR
NAME:
Flood and Peterson
PHONEo (970) 266-7118
A/NEst : FAxAIC, No (970) 506-6846
C
E-MAIL BDanielson@FloodPeterson.com
ADDRESS'
Corporate Mailing Address:
INSURER(S) AFFORDING COVERAGE
NAIC #
PO Box 578
Greeley CO 80632
INSURERA: Union Insurance Company
25844
INSURED
INSURER B : Plnnacol Assurance
41190
INSURER C :
Hageman Earth Cycle, Inc.
INSURER D :
3501 E. Prospect Road
INSURER E :
INSURER F :
Fort Collins CO 80525
COVERAGES CERTIFICATE NUMBER: CLI891725197 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
ILTR
TYPE OF INSURANCE
INSD
WVD
POLICY NUMBER
MMIDDfYYYY
MM DDIYYYY
LIMITS
X
COMMERCIAL GENERAL LIABILITY
EACH OCCU RRENCE
$ 1,000,000
CLAIMS -MADE � OCCUR
PREMISES Eccu aorrence
$ 300,000
X
MED EXP (Any one person)
s 10,000
$500 Deductible -
Property Damage
PERSONAL& ADV INJURY
$ 1,000.000
A
CPA2344893-36
12/01/2017
12/01/2018
GEN'LAGGREGATE LIMITAPPLIES PER.
GENERAL AGGREGATE
$ 2,000,000
X POLICY ❑JECT PRO ❑ LOC
PRODUCTS - COMP/OPAGG
$ 2,000,000
S
OTHER
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
Ea accident
g 1,000,000
BODILY INJURY (Per person)
S
X ANY AUTO
A
OWNED SCHEDULED
AUTOS ONLY AUTOS
CPA2344893-36
12/01/2017
12/01/2018
BODILY INJURY (Per accident)
S
PROPERTY DAMAGE
Per accident
$
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
Medical payments
$ 5,000
X
UMBRELLA LIAR
X
OCCUR
EACH OCCURRENCE
$ 2,000,000
A
EXCESS LIAB
CLAIMS -MADE
CPA2344893-36
12/01/2017
12/01/2018
AGGREGATE
5 2,000,000
DED RETENTION $
5
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y I N
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
NIA
4036218
10/01/2018
10l01/2019
X STATUTE I I EERH
E.L. EACH ACCIDENT
$ SOO,000
E.L. DISEASE - EA EMPLOYEE
S 500,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE- POLICY LIMIT
S 500,000
A
Leased/Rented Equipment
CPA2344893-36
12/01/2017
12/01/2018
Limit
$230,000
Deductible
$1, 000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Certificate holder is included as Additional Insured as required by written contract with respects to liability arising out of work performed by the named
insured.
CFRTIFICATF HOI DFR CANCELLATION
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.
P.O. Box 580
AUTHORIZED REPRESENTATIVE
Fort Collins CO 80522
VUvAt nie:SOti.
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