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HomeMy WebLinkAbout129302 HAGEMAN EARTH CYCLE - INSURANCE CERTIFICATE (16)DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE F12/4/2015 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 CONTACTValerie Love, CIC, CISR NAME:ME: Flood and Peterson PHoiN . 970-506-3215 1 f Nu: (970)330-1867 PO Box 578 ADDRESS:vlove@floodpeterson.com INSURER(S) AFFORDING COVERAGE NAIC # Greeley CO 80632 INSURERA:Continental Western 10804 INSURED INSURERB:Pinnacol Assurance _ 41190 Hageman Earth Cycle, Inc. INSURERC: 3501 E. Prospect Road INSURER0: INSURER E : Fort Collins CO 80525 INSURER F: COVERAGES CERTIFICATE NUMRFR-CL1512207439 RFVISInN NIIMRFR- 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 I ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE wqn wyn POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence A CLAIMS -MADE X OCCUR $ 100, 000 MED EXP (Any one person) CPA234489333 12/1/2015 12/1/2016 $ 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 _ GENI AGGREGATE LIMIT APPLIES PER, GENERAL AGGREGATE $ 2,000,000 X POLICY PECT LOC PRODUCTS - COMP/OPAGG $ 2,000,000 WAIVE OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 X BODILY INJURY (Per person) $ A ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS CPA234489333 12/1/2015 12/1/2016 BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE Per accident $ Medical Payments $ 5,000 X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 A EXCESS LIAB CLAIMS -MADE CPA234489333 12/1/2015 12/1/2016 DED I I RETENTION $ WORKERS COMPENSATION EMPLOYERS' LIABILITY Y/N X STATUTE ER STATUTE E.L. EACH ACCIDENT $ 500,000 B ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) N / A 4036218 10/1/2015 10/1/2016 E.L. DISEASE- EA EMPLOYEE $ 500,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Fort Collins is listed as an Additional Insured in regards to General Liability. loth I IVIGA I t HULUtH GANUELLA I IUN City of Fort Collins 215 N. Mason;PO Box 580 Fort Collins, CO 80522-0000 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 V Love, CIC, CISR/VLO C © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (201401) Additional Named Insureds Other Named Insureds Bigfoot Properties LLC Additional Named Insured Dry Gulch Land, LLC Additional Named Insured Glacier Rock Company Additional Named Insured Hageman Earth Cycle, Inc. Additional Named Insured Hageman Enterprises, LLC Additional Named Insured OFAPPINF (02/2007) COPYRIGHT 2007, AMS SERVICES INC