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HomeMy WebLinkAbout120528 FORT COLLINS TREE CARE INC - INSURANCE CERTIFICATE (11)FORTCOL-09 CWATSON '4�o�Ro CERTIFICATE OF LIABILITY INSURANCE DAT37/2 DlYYYV) /7/2016 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 CONTANAME: CT Angela Gross TrueNorth PHONE 303 776-5122 FAX PO Box 847 1 No. Ert►: ( (a/c, No): (303) 776-5495 Longmont, CO 80502 ADDRESS: INSURED Fort Collins Tree Care, Inc 301 East Douglas Road Fort Collins, CO 80524 INSURERS AFFORDING COVERAGE NAIC # MRA;Twin City Fire Insurance Company 129459 ;tERB:Pinnacol Assurance Company 141190 INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NLIMRFR RFVI_CIC11J NIiMRPR- 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 SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICYNUMBER MMIDDIYYYY MM/DDlYYYY - -- LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X J OCCUR i34UUNSR3900 03/05/2016 03105(2017 EACH OCCURRENCE DAMAGE TO REN= 11 PREMISES Ea occurrence) $ 1,000,00 $ 300,00 MED EXP (Any one person) $ 10,00 PERSONAL& ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,00 GEML AGGREGATE LIMIT APPLIES PER: POLICY ^ JET LOC PRODUCTS -COMP/OPAGG $ 2,000,00 $ OTHER AUTOMOBILE LIABILITY MBINED SINGLE LIMIT (Eaacadent�_ $ 1,000,00 A X ANY AUTO 34UUNSR3900 03/05/2016 03/05/2017 BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS P 'BODILY INJURY eraopdten ( ) $ X HIREDAUTOS X AUTO -OWNED MAGE FIR(Per $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB _ CLAIMS -MADE DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY B ANY PROPRIETOR/PARTNER/EXECUTIVE YfN OFFICER/MEMBER EXCLUDED? (Mandatoryin NH) If yes, describe under DESCRIPTION OF OPERATIONS below 4148327 05/01/2015 05/01/2016 NIA TH- X I STATUTE ER E.LEACHACCIDENT _ $ 100,00 E.L. DISEASE - EA EMPLOYEE - E.L. DISEASE -POLICY LIMIT $ 100,000 $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Fort Collins as Additional Insured as required by written contract per General Liability policy form. CERTIFICATE HOLDER CANCELLATION City of Fort Collins Purchasing Division P O Box 580 Fort Collins, CO 80522 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 ZiII 01 4 © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD