HomeMy WebLinkAbout386996 WESTERN STATES RECLAMATION INC - INSURANCE CERTIFICATE (2)Client#:33774
WESSTAPC
ACORD.
CERTIFICATE OF
LIABILITY INSURANCE
DATE(MrrIDD/YYY+)
61261 12020
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATEHOLDER. 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 CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the poliey(ies) must have ADDITIONAL INSURED provisions or be -endorsed.-
It SUBROGATION IS WANED, subject to the terms and Conditions of the policy, certain policies may require an endorsement A statement on
this certificate does not confer any rights to the certificate holder In lieu of such endorsement(s).
Holmes Murphy -Colorado
7600 East Orchard Road, Suite 230 South
Property Casualty -Colorado
Greenwood Village, CO 80111
INSURED
Western States Reclamation, Inc.
3756 Imperial Street
Frederick, CO 80516
COVERAGES
Nick Brown
Co of America
INSURER D : Admiral Insurance 124355 1
INSURER E :
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE
EXCLUSIONS AND CONDITIONS OFSUCHPOLICIES. LIMITS
BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR
TYPE OF INSURANCE
IN L
y5Uyy0p
_
POLCY NUMBER
MIWD EFF
MPOLI EXP
UNITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE 7 OCCUR
PD Ded:.$2,500
X
DTC03
6D029ATiL20
7/01/2020
07/01/2021
EACH OCCURRENCE
$1 OOOOOO
PREMISE EeEom D,.
$300000
X
MEDEXP Anyoneperson)
$5000
PERSONAL B ADV. INJURY
$1000000
GEN'L AGGREGATE LIMIT APPLIES PER
POUCY F J Ca LOC
OTHER:
GENERAL AGGREGATE-
-s2,000,000
PRODUCTS-COMP/OP AGG
S2,000,OOO
$
A
AuToMosiLEUAmuTY
ANY AUTO
OWNEDSCHEDULED
AUTOSONLY AUTOS. AUTOS ONLY )( NON -OWNED
AUTOS ONLY
IX
8162N222190TIL2026
D710112020
07/01/2021
COMBINED ISINGLE LIMIT
1,000,000
BODILY INJURY(Per person)
$
BODILY INJURY(Per accident)
$
PROPERTY DAMAGE
Per eaidem
$
A
X
UMBRELLA LAB
EXCESS LAB
X
OCCUR
CLAIMS -MADE
CUP(IJ2166662026
7/01/2020
07/01/2021
EACH OCCURRENCE
$5 000 000
AGGREGATE
$5 00O 000
DED I X RETENTION $10000
$
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETORIPARTNERIEXECUTIVE YIN
OFFICERIMEMBER EXCLUDED? �
(Marxietory in NH)
If DE es
Se desnbeunMF OPERATIONS below
NIA
420278,Jr
0710112020
07/01/2021
X I PERITE OTH-
E.L. EACH ACCIDENT
$1 000 000
E.L. DISEASE - EA EMPLOYEE
$1 00O 000
E.L. DISEASE -POLICY LIMB
$1000000
C
C
D
Leased/Rented Eq.
Installation Fit.
Poll/Prof Liab.
QT6602A931946TIA
QT6602A931946TIA
FEIEC61629707
-
•
7/07/2020
7/01/2020
7/OM020
07/01/2021
07/01/2021
67/01/2021
$1,006,600•, $2,500 Ded
$250,000; $1,000 Ded
$2 060 000• $10 000 Ded
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Addigonal.Remarks
Project Description: Landscaping Project at Horsetdoth
The Certificate Holder is an Additional Insured on the
and Business Automobile Liability, as required by written
Schedule, maybe alteehed If more space Is required)
and Timberline.
General Liability, including Completed Operations,
contract, per policy terms and conditions.
City of Fort Collins SHE ULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
PO BOX 580 ACCORDANCE WITH THE POLICY PROVISIONS.
Fort Collins, CO 80522
AUTHORIZED REPRESENTATIVE
01988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD
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