HomeMy WebLinkAbout361699 ZAK GEORGE LANDSCAPING LLC - INSURANCE CERTIFICATE (4)A� R®® CERTIFICATE OF LIABILITY INSURANCE
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THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIFlMATNELY 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
REPRESENTATIVEOR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT" Ifthe oertificate holder Is an ADDITIONAL INSURED; the policy(les) musthave ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATIONIS WANED, 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 cerkcate holder in lieu of such h endors_ement(s).
PRODUCER
NAME CONCT Kylle.Carey, CISR, CIC
Flood and Peterson
PHONE (970) 266-7148 _ _ P No. _(970) 506-6845
No. Exr,PO
Box'576
E-MAIL KCar 0floo etersoh.com
ADDRESS:- _ ey-_... __ _ _ _.
. __..._—_.- ... .INSURE_ AFFORDING. COVERAGE. ._ _
_NAIC8
INSURER A: Cincinnati Ind emn' _ Co _ . -- -
23280
Greeley - CO 80632 ___
INSURED - - - - - - - - -- - _ .. .. -- -
INsuRERe:: PmnagolAs-auranca - ----- ------ -._.._ _ _----
-- 41190 --
INSURER C:
Zak GeorgeLartdsca in , LLC
- - - p g
INSURER D
335 S. Summit View Drive
INSURER E:
Fort Collins CO 80524
INSURER F:
COVERAGES CERTIFICATE NUMBER: FwlCeroc4/1/21 -ZCaL 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 CONTRACTOR 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.
-
TYPE OF INSURANCE
- -"-
POLICY NUMBER
POLICY EFF
MMO)
PO Y.EXP
-
LIMITS
COMMERCULLGENERALLIABILn'Y
EACH, OCCURRENCE
$ 1,000,000
rA
CLAIMS -MADE 19 OCCUR
PREMISES Eeoccurrence
$ 500,000
MEDEXP An one -rson
$ 10,000
PD Ded.:$1,000
PERSONALS ADV INJURY
$ 1,000,000
EPP0472465
04/01/2020
04/01/2021
GEN'LAGGREGATE LIMIT APPLIES PER:
GENERALAGGREGATE
$ 2,000,000
POLICY ® PRO-
JECT 7 LOC
'PRODUCTS -COMPNPAGG
$ 2,000,000
Stop -Gap - WY
$ 1,000,000
OTHER:
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
(Ea accident)
$ 1,000,000
BODILY INJURY (,Per
$
ANYAUTO
A
OWNED SCHEDULED
EPP0472465
04/01/2o20
04/01/2021
BODILY INJURY (Per accident)
$
AUTOS ONLY AUTOS
PROPERTY DAMAGE
$
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
Per accIdent - —
Medical payments
$ 5,000
UMBRELLA LIAR
OCCUR
.EACH OCCURRENCE.__ __ _ _..
,$- 5,000,000
-
.AGGREGATE - .__- _ _ _
$_ 5.000,000
A
EXCESS
CLAIMS -MADE
EPP0472465
04/01/2020
04/01/2021
DED - RETENTION.$. ___ __
_ -
...
$
. -
_ _
.. _ .._ .-_.. _ _ _. __ -..—
_.. _ .._
WORKERS COMPENSATION
.PER--. _ _-
.OTM_
AND EtrPLOYERS' LIABILITY TY
STATUTE
'R
-
E.L. EACH ACCIDENT
$ 1,30003000
B
ANY PROPRIR/PARTNEPoEXECIITNE
oFFICER/MEMBEMeEREXCLUDEDa �
N/A
4103537
-
04/Ot/2020
-
04/O7/2021
E.L. DISEASE - EA EMPLOYEE
_ _
I10091000
-
(Mandatory In NH) - - -
If Yes. describe under
DESCRIPTION OF OPERATIONS below
_
_ _
_ .__ _ __ _ —
E.L. DISEASE-. POLICY LIMB
1 000,000 .
Leased/Rented Equipment
A
EP00472465
64/01/2020
04/01/2021
$50,000 Limit
$2,500 Ded.
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more apace 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, With respect to the General. Uaolity and Auto Liability policies.
The City of Fort Collins Purchasing Department
P.O. Box UO
Fort Collins
CO 80522
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BECANCELLEDBEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD