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HomeMy WebLinkAbout113664 JORDAN'S TREE MOVING & MAINTENANCE INC - INSURANCE CERTIFICATE (4)----1 OP ID: SLS
,acoREY CERTIFICATE OF LIABILITY INSURANCE DATE/27/20Y
1227/208
18
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 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 Phone: 970-223-1804 CONTACT
Front Range Insurance Group PHONE FAX
2002 Caribou Drive, Ste. 101 Fax: ac No Ext : A/C No):
Fort Collins, CO 80525 E-MAIL
David A. Wooldridge LUTCFAAI PRODUCER CI ICTnMFR in rr JORDA'2
INSURED Jordan's Tree INSURER A: Secura Insurance Companies 22543
Moving & Maintenance, Inc INSURER B : Pinnacol Assurance 41190
1025 Smithfield Drive
Fort Collins, CO 80524 INSURERC:
INSURER D :
INSURER E :
INSURER F :
COVERAGES CERTIFICATE NLIMRFR! REVISION NLIMRFR-
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.
INSR
LTR
OF INSURANCE
ADDTYPE
lNSR
UB
POLICY NUMBER
MM DD/YYYY
MM/ DDIYYYY
LIMITS
A
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE FXI OCCUR
X Prof Liab
X
CP003200287-3
CP003200287-3
12/19/2018
12/19/2018
12/19/2019
12/19/2019
EACH OCCURRENCE
$ 1,000,00
PREMISES Ea occurrence
$ 300,00
MED EXP (Any one person)
$ 10,00
PERSONAL & ADV INJURY
$ 1,000,00
GENERAL AGGREGATE
$ 2,000,00
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY X PRO LOC
PRODUCTS - COMP/OP AGG
$ 2,000,00
Prof Liab
$ 1,000,00
A
A
A
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON-OWNEDAUTOS
X
A3200288
A3200288
A3200288
12/19/2018
12/19/2018
12/19/2018
12/19/2019
12/19/2019
12/19/2019
COMBINED SINGLE LIMIT
(Ea accident)
$ 1,000,00
X
X
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
X
PROPERTY DAMAGE
(Per accident)
$
X
$
UMBRELLA LIAB
EXCESS LIAR
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
$
AGGREGATE
$
DEDUCTIBLE
RETENTION $
$
$
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVEY�
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
N/A
4040726
03/01/2018
03/01/2019
X WC STATU- OTH-
TORY LIMITS ER
E.L. EACH ACCIDENT
$ 1,000,00
E.L. DISEASE - EA EMPLOYE
$ 1,000,00
E.L. DISEASE - POLICY LIMIT
1 $ 1,000,00(
A
Equipment Floater
CP003200287-3
12/19/2018
12/19/2019
Leased 250,00
Ded 50
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
The City of Fort Collins, its officers, agents and employees are named as
additional insured with regards to general and auto Liability.
GtK I IFIGA It: HULUtK L;ANL;tLLA I IUN
CITY OF
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.
Puchasing Dept.
PO Box 580 AUTHORIZED REPRESENTATIVE
Fort Collins, CO 805221.(� 1 G ��
I
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