HomeMy WebLinkAbout109005 POUDRE VALLEY AIR OF NORTHERN COLORADO INC - INSURANCE CERTIFICATE (3)ACil CERTIFICATE
Ii _ .. .. .
OF LIABILITY INSURANCE
1
DATE (MM DD/YYYY)
1 06/03/2020
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMAT'ON
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELYjAMEND,
EXTEND OR ALTER THE COVERAGEAFFORDED 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 ADDITIONACINSURED,
the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
H SUBROGATION IS WAIVED, subject to the terns and conditions
this certificate does not confer rights to the certificate_ holder
of the policy, certain policies may requirean endorsement A statement on
in lieu of such endorsement(s)..
PRODUCER --
_CONTACT
.NAME:: -Shannon Kammerer
PHONNE (970) 356-0123- -- - - _- Ate : -(970) 330-1867
Flood and Peterson
PO Box 578
noDRess: SKammerer®floodpeterson.com
INSURER AFFORDING COVERAGE
NAIC a
Greeley CO
80632.
INSURER A : Employers Mutual Casualty Company
21415
INSURED
INSURER B : Pinnacol Assurance
41190
Poudre Valley Air Of Northern
INSURER C :
Colorado. Inc
.INSURER D.:.
2416 Donella Court; Suite A
INSURER E i
Fort Collins CO
80524
INSURER F :
COVERAGES CERTIFICATE: NUMBER:' x10/17/19-20 Master REVISION NUMBER:
THIS ISTO CERTIFY THAT THE POLICIES OF INSURANCE LISTED. BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REOUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAYBE 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.
INSLTli
TYPE OF INSURANCEPOLICY
POLICY NUMBER
EFF
MWDD/YY
POLICY EXP.
MM/DD(YYYY)
LIMITS
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
.CLAIMS -MADE ® OCCUR
PREMISES Ea occurrence)_
$ 500,000
MED EXP (Any one Icon
$ 10,000
PERSONAL SADVINJURY
$ 1,000,000
A
5X77586
10/17/2019
10/17/2020
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERALAGGREGATE. _
$. 2.000t000
POLICY PRO- JEGT ❑2,000.000
LOC
PRODUCTS - COMP/OP AGO
$ -
$
OTHER:
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
Ea accident
$ 1,000,000
BODILY INJURY(Perperson)
$
ANY AUTO
A
OWNED SCHEDULED
AUTOS ONLY AUTOS
5X77586
10/17/2019
10/17/2020
BODILY INJURY (Per accident)
S
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
PROPERTY DAMAGE
Peraccidenl
$ 1,000,000
UMBRELLA UAB
OCCUR
.EACH OCCURRENCE
$ 3,000,000
AGGREGATE
$ 3,000,000
A
EXCESS LIAR
ICLAIMS-MADE
5X77586
10/17/2019
10/17/2020
DED.. X RETENTION.$. 0
$
-
_
-"
B
WORKERS COMPENSATION
ANDEMPLOYERTLIABILITY YIN
ANY PROPRIETOR/PARTNER/EXECUTNE
OFFICER/MEMBEREXCLUDEDT a
(Mandatory in NM)
N/A
4074340
_
07/01/2020
-
07/01/2021
- PER - 'OTH=
STATUTE - ER
-- - -
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE -.EA EMPLOYEE
$ 1,000,000
Ifyes. describe under
DESCRIPTION OF OPERATIONS below.
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (ACORD 101, Atldidonal
Remarks Schedule, may be attached if mare apace is required)
COcLTtvinATP Nnl ncn i CANCPI 1 ATIr1N
SHOULD ANY OF THE ABOVE DESCRIBED POUCIES.BE CANCELLED BEFORE
THEEXPIRATION DATETHEREOF, NOTICEVIIILL BE DELIVERED IN
City of Fort Collins Home Efficiency Program
ACCORDANCE WITH THE POLICY PROVISIONS.
PO Box 580
AUTHORIZED REPRESENTATIVE
Fort Collins CO
80522
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