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HomeMy WebLinkAbout106089 WESTERN STATES LAND SERVICES - INSURANCE CERTIFICATE (5)OP ID: JS 140cORO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 11 /16/2015 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 Richards, Seeley, & Schaefer, PHONE FAX Inc. A/C No Ext : A/C Not: _ 3640 W. 112th Avenue E-MAIL Westminster, CO 80031 ADDRESS: PRODUCER WESTE-1 B John Seeley CUSTOMER ID #: INSURERS AFFORDING COVERAGE NAIC # INSURED Western States Land Services INSURER A: American States Insurance 505 N Denver Avenue INSURER B: Pinnacol Assurance 41190 Loveland, CO 80537 INSURER C INSURER D : INSURER E INSURER F : COVERAGES CFRTIFICOTF NI IMRFR• RFVI_CI(1N NI IMRFR- 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. ILICY LTR TYPE OF INSURANCE ADDL INM UB POLICY NUMBER EFF MM /DD/YYYY POLICY EXP MM/DDfYYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE lI OCCUR 02BP85670950 12/15/2015 12/15/2016 EACH OCCURRENCE $ 2,000,00 DAMAGE TO NTE PREMISES (Eaoccurrence)$ 250,00 MED EXP (Any one person) $ 10,00 PERSONAL & ADV INJURY $ 2,000,00 GENERAL AGGREGATE $ 4,000,00 GEN'L AGGREGATE LIMIT APPLIES PER POLICY PRO F LOC PRODUCTS - COMP/OP AGG $ 4,000,00 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS 24CC2767412 01/30/2016 01/30/2017 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (PER ACCIDENT) $ X X $ UMBRELLA LIAB EXCESS LWB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DFnUCTIBLF RETENTION $ $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICERIMEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A 1803222 1110112016 01/01/2017 X WC STATU- OTH- TORY LIMITS E.L. EACH ACCIDENT $ 100,00 E.L. DISEASE - EA EMPLOYEE $ 100,00 E.L. DISEASE - POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) City of Ft Collins are included as additional insureds by contract. I t NULUtK CITY019 City of Ft. Collins Mr O'Neil PO Box 580 Ft. Collins, CO 80522-0580 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 ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD