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HomeMy WebLinkAbout129302 HAGEMAN EARTH CYCLE INC - INSURANCE CERTIFICATE (8)i ACOR" CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 11/20/2018 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 CONTCT NAME: Brianne Danielson, CISR Flood and Peterson NCONNo Ext : (970) 266-7118 FAX No): (970) 506-6846 E-MAIL S: BDanielson@FloodPeterson.com ADDRE Corporate Mailing Address: INSURER(S) AFFORDING COVERAGE NAIC # P.O. BOX 578 INSURERA: Union Insurance Company 25844 Greeley CO 80632 INSURED INSURER B : Pinnacol 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: CL18112026272 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. I�TR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM DDfYYYY MMIDD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE a OCCUR PREMISES Ea occurrence $ 300,000 X MED EXP (Any one person) $ 10,000 $500 Deductible - Property Damage PERSONAL & ADV INJURY $ 1,000,000 A Y CPA2344893-37 12/01/2018 12/01/2019 GEN'LAGGREGATE LIMIT APPLIES PER : GENERAL AGGREGATE $ 2,000,000 PRO - POLICY � JECT PRO ❑ LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accidence_ $ 1,000,000 BODILY INJURY (Per person) $ X ANY AUTO A OWNED SCHEDULED AUTOS ONLY AUTOS Y CPA2344893-37 12/01/2018 12/01/2019 BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY Medical Payments $ 5,000 X UMBRELLA UAB X OCCUR EACH OCCURRENCE $ 3,000,000 AGGREGATE $ 3,000,000 A EXCESSLIA6 CLAIMS -MADE CPA2344893-37 12/01/2018 12/01/2019 DED I I RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED (Mandatory in NH) N / A 4036218 10/01/2018 10/01/2019 PER OTH- X STATUTE 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 A Leased/Rented Equipment CPA2344893-37 12/01/2018 12/01/2019 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. rPRTIFIr:ATF Hrll r1FR 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. Attn: Purchasing Dept. AUTHORIZED REPRESENTATIVE P.O. Box 580 Fort Collins CO 80522�k 7��Ri8iSOti © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD