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HomeMy WebLinkAbout129302 HAGEMAN EARTH CYCLE INC - INSURANCE CERTIFICATE (9)ACORI a �� CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYVYI 09/03/2019 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 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 Brianne Danielson, CISR NAME: PHONE (g70) 266-7118 (970) 506-6846 A/C No Ezt: AIC No: Flood and Peterson E-MAIL SS: BDanielson@FloodPeterson.com ADDRE Corporate Mailing Address: INSURER(S) AFFORDING COVERAGE NAIC e P.O. Box 578 INSURER A: 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 : INSURERF: Fort Collins CO 80525 rnvFRAnrq CFRTIFICATF NUMBER' CL199331312 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. tLTR TYPE OF INSURANCE IN WND POLICY NUMBER MM/DDIYYYY MMIDD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE © OCCUR DAMAGE TO RENTED PREMISES(E urrence $ 300,000 NED EXP An one Person) $ 10,000 r $500 Deductible - Property A Damage Y CPA2344893-37 12/01/2018 12/01/2019 PERSONAL $ADVINJURY $ 1,000,000 GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OPAGG $ 2,000,000 POLICY ® ECT LOC $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ ANY AUTO A OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY Y CPA2344893-37 12/01/2018 12/01/2019 BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ Medical payments $ 5,000 UMBRELLA LIAR OCCUR EACH OCCURRENCE $ 3,000,000 kJ AGGREGATE $ 3,000,000 A EXCESS LIAB CLAIMS -MADE CPA2344893-37 12/01/2018 12/01/2019 DEC) I I RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER(MEMBER EXCLUDED? (Mandabry In NH) NIA 4036218 10/01/2019 10l01/2020 X PER OTH- 7AT ER E.L. EACH 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 I 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. rFRTIFICATF 144711 nPP CANCFI 1. ATION 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 `�t�QeAt 04nt't ill'u O 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD