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HomeMy WebLinkAbout253179 GRAFFITTI'S INC DBA MIKE'S HAULING & CLEANU - INSURANCE CERTIFICATE (2)-�� MIKES-1 OP ID: P6 ACORN" CERTIFICATE OF LIABILITY INSURANCE r 12 211201 YY) 12/21 /2015 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: House Account Brown & Brown Inc PHONE FAX 4532 Boardwalk Dr, Suite 200 A/C No xt E:970�82-7747 A/c No): 970-484-4165 Fort Collins, CO 80525 E-MAIL House Account ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A:Secura Insurance A Mutual Co. 22543 INSURED Graffitti's, Inc. dba: Mike's INSURER B : Plnnacol Assurance Compare/ 41190 Hauling 8r Cleanup Service PO Box 7634 INSURER C Loveland, CO 80537-0634 INSURER D : INSURER E : INSURER F : CC)VFRAGFS CERTIFICATE NLIMRFR- RFVISI0N 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 AD L U R POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE "' I OCCUR 3199628 12/11/2015 12/11/2016 EACH OCCURRENCE $ 1,000,00 TO PDAMAREMIREMI ESES S( RENTED Ea occurrence 1000O $ , MED EXP (Any one person) $ 10100 PERSONAL & ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY u PRO- JECT a LOC OTHER: GENERAL AGGREGATE $ 2,000,00 PRODUCTS - COMP/OPAGG $ 2,000,00 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED X AUTOS SCHEDULED AUTOS NON -OWNED X HIRED AUTOS X AUTOS A3199629 12/11/2015 12/11/2016 COMBINED SINGLE LIMIT Ea accident $ 1,000,00C BODILY INJURY (Per person) _ $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ UMBRELLA LIAB EXCESS LIAR OCCUR CLAIMS MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA 4007823 01/01/2016 01/01/2017 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 500,00 E.L. DISEASE - EA EMPLOYEE $ 500,00 E.L. DISEASE - POLICY LIMIT $ 5O0 00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) FAX 970-221-6782 CITYFT5 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS. Purchasing Sales Tax Division AUTHORIZED REPRESENTATIVE 281 N College Avenue C`cs�►-2� Fnrt Cnllinc CCU RO699 © 1938-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD MIKES-1 PAGE 2 NOTEPAD INSURED'S NAME Graffitti's, Inc. dba: Mike's OP ID: P6 Date 12/21/2015 If required by written contract the following applies. Blanket Additional Insured - Ongoing - CGT1000 1001 Blanket Additional Insured - Completed Operations ILE1037 1105 Primary 6 NonContributory - ILE1037 1105 Waiver of Subrogation - ILE1037 1105 Per Project Aggregate - ILE1037 1105