HomeMy WebLinkAbout357006 ALL AMERICAN BACKFLOW - INSURANCE CERTIFICATE (10)CERTIFICATE OF LIABILITY INSURANCE
DATE(MMiDD/YYYY)
05/22/2019
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 SUBROGATIONIS 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
AFFORDABLE AMR INS/PHS
34343638
NAME:
PHONE (866)467-8730
(A/C, No. Ext):
Fax (888)443-6112
(A/C, No):
The Hartford Business Service Center
3600 Wiseman Blvd
E-MAIL
San Antonio_. TX 78265
ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC♦f
INSURED
INSURER A: The Hartford Casualty Insurance Company
29424
LYNNETTE KEIM DBA ALL AMERICAN BACKFLOW
INSURER B :
3912 W EISENHOWER BLVD
INSURER C :
LOVELAND CO 80537-7904
INSURER D
INSURER E
INSURER F :
COVERAGES CERTIFICATE NUMBER: 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.
INSR
LTR
TYPE OF INSURANCE
ADDL
INSR
SUBR
WVD
POLICY NUMBER
POLICY EFF
MM/DD/YYYY
POLICY EXP
MM!DD!Y YY
LIMITS
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$2,000,000
CLAIMS -MADE OCCUR
DAMAGE TO RENTED
PREMISES rc e
$300,000
MED EXP (Any one person)
$10,000
X
General Liability
A
X
34 SBA PE5367
05/26/2018
05/26/2019
PERSONAL & ADV INJURY
$2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$4,000,000
POLICY ❑ JE O- � LOC
PRODUCTS - COMPIOP AGG
$4,000,000
OTHER:
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
accident)
$2,000,000
ANY AUTO
BODILY INJURY (Per person)
A
ALL OWNED SCHEDULED
AUTOS AUTOS
34 SBA PE5367
05/26/2018
05/26/2019
BODILY INJURY (Per accident)
X
HIRED NON -OWNED
AUTOS X AUTOS
PROPERTY DAMAGE
(Per accident)
UMBRELLA LIAR
OCCUR
EACH OCCURRENCE
EXCESS LIAB
CLAIMS
MADE
AGGREGATE
E
RETENTION $
WORKERS COMPENSATION
PER
OTH-
AND EMPLOYERS' LIABILITY
STATUTE
I
IER
E.L. EACH ACCIDENT
ANY Y/N
PROPRIETOR/PARTNERIEXECUTIVE
OFFICENMEMBER EXCLUDED?
A
E.L. DISEASE -EA EMPLOYEE
(Mandatory In NH)
It yes, describe under
E.L. DISEASE - POLICY LIMIT
DESCRIPTION OF OPERATIONS below
A
EMPLOYMENT PRACTICES
34 SBA PE5367
05/26/2018
05/26/2019
$5,000
LIABILITY
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Those usual to the Insureds Operations. City of Fort Collins are Additional Insured per the Business Liability Coverage Form SS0008.
CERTIFICATE HOLDER CANCELLATION
City of Fort Collins
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
ATTN: Jerri Groves
BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED
215 N MASON ST
IN ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
FORT COLLINS CO 80524-4402
616AI-1 '7f C z�
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