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HomeMy WebLinkAbout128847 CRYSTAL LANDSCAPE SUPPLIES INC - INSURANCE CERTIFICATE (8)CRYST-6 OP ID: VM ACORODATE (MM/DD/YYYY) �, ,� CERTIFICATE OF LIABILITY INSURANCE F0E(MM/ D/YY 015 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 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 NAME: Dave Janssen PFS Insurance Group - JT PHONE 970-635-9400 A/c No : 970-635-9401 4848 Thompson Pkwy, Ste 200 A/C. /C No Ext Johnstown, CO 80534 E-MAIL Dave Janssen ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Pinnacol Assurance Co 41190 INSURED Crystal Landscape Supplies Inc INSURER B: Employers Mutual Casualty Co 6616 N Garfield Ave Loveland, CO 80538-1115 INSURER C INSURER D : INSURER E : INSURER F : r_nx1PRAr;FS CFRTIFICATF NI IMRFR• RFVISION Nt1MRFR- 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 INSD SUB POLICY NUMBER POLICY EFF MM/DDIYYYY POLICY EXP MM/DD/YYYY LIMITS B X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS-MADE Al OCCUR 4D84863 12/01/2014 12/01/2015 PREMI ETORENTED PREMISES Ea occurrence $ 100,00 X MED EXP (Any one person) $ 5,00 Blkt Al by Agree PERSONAL & ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 POLICY JE LOC X PRODUCTS -COMP/OP AGG $ 2,000,00 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,00 BODILY INJURY (Per person) $ B X ANY AUTO 4E84863 12/01/2014 12/01/2015 BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS X X NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Per accident $ _ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,00 AGGREGATE $ 1,000,00 B EXCESS LIAB CLAIMS -MADE 4J84863 12/01/2014 12/01/2015 DED X RETENTION $ 10,000 1 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YINA ANY PROPRIETOR/PARTNER/EXECUTIVE 4041312 06/01/2015 06/01/2016 PER OTH- X STATUTE X ER E.L. EACH ACCIDENT $ 1,000,00 OF EXCLUDED? (Mandatory in NH) N/A BLKT WOS E.L. DISEASE - EA EMPLOYEE $ 1,000,00 E.L. DISEASE - POLICY LIMIT 1 $ 1,000,00 If yes, describe under DESCRIPTION OF OPERATIONS below B Inland Marine 4C84863 12/01/2014 12/01/2015 Leased/Re 25,00 Ded 1,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) If required by written contract or written agreement, the City of Fort Collins is included as Additional Insured for ongoing operations under General Liability. CERTIFICATE HOLDER CITYOFC City of Fort Collins 215 North Mason Street Fort Collins, CO 80524 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD