HomeMy WebLinkAbout107133 BATH INC - INSURANCE CERTIFICATE (6)� Q®
A
�r..�►� CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
10/30/2018
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 Jennifer Winter, CISR
NAME:
ni N Ext : (970) 506 3206 C No : (970) 506-6846
Flood and Peterson
E-MAIL JWinter@floodpeterson.com
ADDRESS:
PO Box 578
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURER A: Union Insurance Company
25844
Greeley CO 80632
INSURED
INSURER B : Pinnacol Assurance
41190
INSURER C :
Bath, Inc.
INSURER D :
2000 E. Prospect Road
INSURER E :
INSURER F :
Fort Collins CO 80525
rrnv=onr_cc f FRTIFIr`ATF NI IMRFR• CL18103025938 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
MM/DDYEFF
/YYYY
POLICY EXP
MM DDIYYYY
LIMITS
X
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
CLAIMS -MADE I X1 OCCUR
DAMAGE TO RENTE17-300,000
PREMISES Ea occurrence
$
X
MED EXP (Any one person)
$ 10,000
PD Ded:500
PERSONAL& ADV INJURY
$ 1,000,000
A
CPA315208422
11/01/2018
11/01/2019
GEN'LAGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS - COMP/OP AGG
$ 2,000,000
POLICY [X PRO-
ECT 7 LOC
$
OTHER:
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
Ea accident
$ 1,000,000
BODILY INJURY (Per person)
$
X ANYAUTO
BODILY INJURY (Per accident)
$
A
OWNED SCHEDULED
AUTOS ONLY AUTOS
HIRED �/ NON -OWNED
X AUTOS ONLY AUTOS ONLY
CPA315208422
11/01/2018
11/01/2019
PROPERTY DAMAGE
Per accident
$
$
X DOC
X
UMBRELLA LIAB
X
OCCUR
EACH OCCURRENCE
$ 5,000,000
A
EXCESS LIAB
CLAIMS -MADE
CPA315208422
11/01/2018
11/01/2019
AGGREGATE
$ 5,000,000
DED I X1 RETENTION $ 0
$
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN N
ANY PROPRIETOR/PARTNER/EXECUTIVE �
In N ER EXCLUDED?
(Mandatory In NH)
(Mandatory
N/A
4015110
11/01/2018
11/01/2019
X ER STATUTE
E.LEACH ACCIDENT
1,000,000
$
E.L. DISEASE - EA EMPLOYEE
1,000,000
$
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
RE: Neighborhood Street Tree Replacement #7205
City of Fort Collins, its officers, agents, and employees are listed as Additional Insureds as respects General Liability, including completed operations, and
Auto Liability. Insurance is primary and non-contributory.
CERTIFIGAIE HL)LDtK t,Ftnit,CLLNI IUN
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.
PO Box 580
AUTHORIZED REPRESENTATIVE
Fort Collins CO 80521 I
(c) 1988-2015 ACORD GOKPUKAI IUN. All rignts reservea.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD