HomeMy WebLinkAbout109005 POUDRE VALLEY AIR OF NORTHERN COLORADO - INSURANCE CERTIFICATE (3)ACORI a
CC) CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
10/10/2018
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 Shannon Kammerer
NAME:
Flood and Peterson
ONNo Ext : (970) 356-0123 ac No): (970) 330-1867
E-MAIL SKammerer@floodpeterson.com
ADDRESS:
PO Box 578
INSURER(S) AFFORDING COVERAGE
NAIL #
Greeley CO 80632
INSURERA: Employers Mutual Casualty Company
21415
INSURED
INSURER B : Pinnacol Assurance
41190
INSURER C :
Poudre Valley Air of Northern
INSURER D :
Colorado, Inc
INSURER E :
2416 Donella Court, Suite A
INSURER F :
Fort Collins CO 80524
COVERAGES CERTIFICATE NUMBER: x10/17l19Master 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.
INTR
TYPE OF INSURANCE
INSD
WVD
POLICY NUMBER
MM/DDYYYYY
MM1DD YYYY
LIMITS
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1.000,000
CLAIMS -MADE ®GCCUR
PREMISES Ea occurrence
$ 500,000
MED EXP (Any one person)
$ 10,000
PERSONAL & ADV INJURY
$ 1,000,000
A
5X77586
10/17/2018
10/17/2019
GEN'L AGGREGATE LIMIT APPLIES PER
GENERAL AGGREGATE
s 2,000,000
POLICY ❑ IRO- ❑ LOC
JECT
PRODUCTS-COMP/OPAGG
$ 2,000,000
$
OTHER:
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
Ea accident
$ 1,000,000
BODILY INJURY (Per person)
$
ANY AUTO
A
OWNED SCHEDULED
AUTOS ONLY AUTOS
5X77586
10/17/2018
10/17/2019
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
Per accident
$
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
Uninsured motorist
$ 1,000,000
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$ 3,000,000
AGGREGATE
$ 3,000,000
A
EXCESS LIAB
CLAIMS -MADE
5X77586
10117/2018
10/17/2019
DED I X1 RETENTION $ 0
$
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR,'PARTNERiEXECUTIVE
OFFICERiMEMBEREXCLUDED?
(Mandatory In NH)
N/A
4074340
07,01/2018
07/01/2019
PER OTH-
STATUTE I I ER
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
1.000,000
s
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required)
L,ANI,CLLAI IUIV
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Fort Collins Home Efficiency Program ACCORDANCE WITH THE POLICY PROVISIONS.
PO Box 580
AUTHORIZED REPRESENTATIVE
Fort Collins CO 80522
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