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HomeMy WebLinkAbout462834 FOOTHILLS LANDSCAPE MAINTENANCE LLC - INSURANCE CERTIFICATE (5)CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 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: PHONE FAX (A/C, No, Ext): (A/C, No): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 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 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES (Ea occurrence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- LOC PRODUCTS - COMP/OP AGG $ JECT OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY STATUTE ER Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N / A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN NOTEPAD INSURED'S NAME Date PAGE FHLAN-1 2 Foothills Landscape OP ID: H2 10/15/2015 The following apply when required by contract: GENERAL Additional LIABILITY: Insured On-going & Completed Operations CG7246 09/08 Primary/Blanket Non-Waiver Contributory of Subrogation Wording CG7323 CG7246 11/09/11 08 Per Project Aggregate CG7323 11/11 AUTOMOBILE Additional LIABILITY: Insured On-going Operations AC0102 03/10 Blanket Waiver of Subrogation AC 0101A 03/10 UMBRELLA LIABILITY: Following form WORKERS' Blanket Waiver COMPENSATION: of Subrogation 359-B 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 Tyler B. Allen FHLAN-1 OP ID: H2 10/15/2015 Jody Wagner Brown & Brown Inc 4532 Boardwalk Dr, Suite 200 Fort Collins, CO 80525 Tyler B. Allen 970-482-7747 970-484-4165 jwagner@bbcolorado.com Pinnacol Assurance Company 41190 Foothills Landscape AMCO Insurance Company 19100 Maintenance, LLC P. O. Box 189 Windsor, CO 80550-0189 Nationwide Mutual Fire Ins Co. 23779 B X 1,000,000 X X ACPGLAO3007035175 05/01/2015 05/01/2016 100,000 10,000 1,000,000 2,000,000 X 2,000,000 1,000,000 C X X ACPBA3007035176 05/01/2015 05/01/2016 X X 2,000,000 B ACPCAA3007035176 05/01/2015 05/01/2016 2,000,000 X 0 X A 4154852 04/01/2015 04/01/2016 1,000,000 N 1,000,000 1,000,000 B Equipment Floater ACPCIM3007035175 05/01/2015 05/01/2016 Lsd/Rtd 50,000 Ded 1,000 The certificate holder is included as an additional insured per forms and conditions shown on page 2. CITYFC2 City of Fort Collins PO Box 580 Fort Collins, CO 80522