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HomeMy WebLinkAbout102136 KORBY LANDSCAPE LLC - INSURANCE CERTIFICATE (12)AC40R0 CERTIFICATE OF LIABILITY INSURANCE DATE(MMODMYY) 05/07/2015 OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS THIS CERTIFICATE IS ISSUED AS A MATTER CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE 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). PRooucER NTACT Michaela R Ows MOUNTAIN PLAINS AGENCY LLC PHONE actin 15AL 970 206.0800 __- IAIAXC NoY. 97 6.0 1 4532 MCMURRY AVE ADDDRESS: owsleml@nationwide.com - STE101 INSURER(S) AFFORDING COVERAGE NAICO FORT COLLINS CO 80525-8023 INSURERA: NATIONWIDE MUTUAL INSURANCE COMPANY 23787 INSURED mSURER D: DEPOSITORS INSURANCE COMPANY 42587 19100 INSURERC: AMCO INSURANCE COMPANY _..__._. —..— KORBY LANDSCAPE, LLC INSURER D_ 2406 E COUNTY ROAD 60 INSURER E _ _y—-- WELLINGTON CO 80549-1614 INsuNER F: COVERAGES a.crt 111.1. 1 c lrv'I 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. _ INSRI LTR G� lI '`� ,ADDLSUBR TYPEOFINSURANCE X COMM ERCIALGENERALUABILRY r��CLAIMS-MACE CUR INSO X WW � POLICYNUMBER ACP GLAD 3006865981 POLICY EFF MM'DOIYYY 11/11/2014 POLICY EXP MIAI 1 11/11/QO15 i LIMITS EACH OCCURRENCE S 1,000.000 A�GMA EiEiJ�ED PRMSES(E.,ina,w) 5 100,000_ -. PIER EZP(Anp Is 5,000_,_ _ 1,000,000 - S 2,000.000 5 2000.000 - S DVINJUN PERSONAL A ADV INJURY 'Is GENERAL AGGREGATE PRODUCTS COMPlOP AGO GEN1 AGGREGATE LIMIT APPLIES PER PRO- X POLICY JECT �� LOC OTHER: AUTOMOBILELABILRY COMBINED INGL LIMIT zRzdent $ 1,000.000 BODILY INJURY (Pen pawn) S B - ANY AUTO AUTOOOMED SS wI AAiITHOSULED �^-� NONAVJIJEp x HIREDALTOS 'AUTOS X ACP BAPD 3006865981 11/11/2014 '11/11/2015 6001LY INJURY (Pen PROPF_ WDAMAGE Per acndenrt s C UMBRELLA LIA6 X OCCUR ^Excess LlAB CLAIMBMHDEI LIED RD ENTIDNS wORKERSDOMPENSAILIT X ACP CAA 3006865981 I 11/11/2014I11111/2015 jEAGHOGCURREN'CE _S_1,000,000 AGGREGATE :. PER O F.- STATUTE ER 5 1,000,D00 5 _ E.L EACH ACCIDENT 5 AND EMPLOYERS' LIABILITY YIN ANYPROPRI ETORIPARTNERIE ECUTIVE OFFICER:M£MBER EYCL J MO? fMAntlarory in NH) IF yes, tlesclibe antler DESCRIPTION OE OPERATIONS bebw N/A' i I I I IEL DISEASE -FA EMPLOYEES j E L. DISEASE � POLICY LIMIT i 5 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IA CORD 101. Addition Rema,KS ScHNI.I., may b.... hed H..ni spat¢ IS IiIiiinnn The City of Fort Collins Streets Department is included as additional insured in respects to the referenced. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES THE EXPIRATION DATE THEREOF, NOTICE W ACCORDANCE WITH THE POLICY PROVISIONS - City of Fort Collins Streets Department AUTHORIZED REPRESENTATIVE 625 9th Street Michaela R. Owsley� Fort Gollins CO 00524 ©1988-201 DELIVERED IN ACORD 26 (2014101) The ACORD name and logo are registered marks of ACORD ACORDTA INSURANCE DATE(MMNDYYYY) CERTIFICATE OF LIABILITY 0.iNT 2015 PRODUCER 7501 Eol Assurance 501 E Lowry Blvd Denver, CO 80230-7006 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC# INSURED WSURERA: Pinn cal Assurance 41190 Korby Landscape LLC 2406 W County Road 60 Wellington, CO 80549 INSURER B: INSURER C. INSURER D: LUSURER E COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDNG ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMMENT 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 ADO, PDUCY EFFECTIVE POUCYWIRATION LTR INWO TYPE OF MSURANCE POUCYNUIVII OATE(FMND/YYYY WTE(MLVODMTY LILIRS GENERAL LM80.1TY EACHOCCURRENCE UAAMGE TO RENTED LOMLIERGAL GENERAL LIABILITY CUIMS MADE El OCCUR me'UsES Lazo Pm MfISONAL4ADV INIURY GENLAGGREGATEUMITAPPUERS PER: GENERAL AGGRELNIE PAO UCTS-COMPIOPAGG POLICY PROJECT LOC AUTOMOBNE LIABILRY CONOWED SINGLE LIMIT ANv AUTO Ea A( 0 WOILYINJURY AU OWNED AUTOS SCHEDULED AUTOS (Per PereoM BODILY MOURY HIREO AUTOS NN YJNED AUTOS IFYrydY.0 PROPERTY DAMAGE IPeraccMenU GAR "WBILRY AUTOONLY-EAACOI T OTHFi THAN UACC ANY AUTO AUTOONLY: AG EZCESLUYBNFLU WBILOY EACH OCCURRENCE AGGREGATE —OR CLAIMS MADE DEDUCTIBLE RETF..W $ "IbUiRSOORMENSATIONAND WC STATU- OTHFR A ENPLOYE"M/,BIL. ANYPROPRIETOWPARTNEfVFXECUTrvE 4171624 03/01/2015 03/01/2016 TORY LIMITS ETEACHACCIOENT $1W.000 EL D5EASE-EAEMPLOVEE $mD,avD OFFICOWEMBER "CLUDED? If Yes, pease dez[nM under$PECML PROVISIONS Mk E105EAM-PCUCYU IT OTHER DESCRIPTION OF pPFRATN)NSILOGHTIONSNENICL£SIE]IGW810N8 ADDED BY ENDORSEIA N MPECUA PROV6NlNS CERTIFICATE HOLDER CANCELLATION 1610460 City of Fort Collins Streets Department 625 9th Street - Fort Collins, CO 80524 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO NOTIFY 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO NOTIFY SUCH NOTICE SMALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Joseph Sanchez ACORD 25(2001/08) Underwriter _ ACORD CORPORATION 1988 CERTIFICATE HOLDER COPY City of Fort Collins Streets Department 625 9th Street Fort Collins, CO 80524 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.