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HomeMy WebLinkAbout593124 HILLCREST TREE FARM - INSURANCE CERTIFICATEHILLC-1 DATE(MM/DD/YYYY) 03/13/2018 ACORO CERTIFICATE OF LIABILITY INSURANCE `—� 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 have ADDITIONAL INSURED provisions or 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 endorsements . PRODUCER 559-897-5811 Kingsburg Insurance Agency License #0504756 P.O. Box 100 Kingsburg, CA 93631 Bruce A. Blayney CTNAOM NM CT Lori Saubert PHONE 559-897-5811 FAX 559-897-1663 (A/C, No, Ext): (A/C, No): E- f IE : Isaubert@kingsburgins.com INSURERS AFFORDING COVERAGE NAIC # INSURER A: Admiral Insurance Company INSURED Hillcrest Shops INSURER B : State Compensation dba Sean & Melissa Bautista 6943 S. Reed INSURER C : `7 United Financial Casualty Co. 11770 INSURER D : Reedley„ CA 93654 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 LTRTYPE OF INSURANCE ADDL SUBR WVD POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE V OCCUR Y CA000012270-11 12/18/2017 12/18/2018 EACH OCCURRENCE $ 1,000,000 DAMAGEREMISES ( a ocTED curren $ 50,000 MED EXP (Any oneperson) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 L AGGREGATE LIMIT APPLIES PER: POLICY PRO ❑ LOC JECT M'OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 C AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY X AUTOS HIRED NON -AWNED AUTOS ONLY AUTOS ONLY y 08010166-6 05/26/2017 05/26/2018 COMBINED SINGLE LIMIT 1,000,000 $ BODILY INJURY Perperson) _ $ BODILY INJURY Per accident $ PROPERTY DAMAGE Per accident $ UMBRELLA LIAB EXCESS LIAB OCCUR EACH OCCURRENCE $ HCLAIMS-MADE AGGREGATE $ DED I I RETENTION $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY N ANY PROPRIETOR/PARTNER/EXECUTIVE U GPFICERiMEMBER EXCLUDE (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N i A 9098212-18 05/01/2018 05/01/2019 PER OTH- T EACH PCCICENT 1.000.000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Certificate holder is named as additional insured per GL forms CG 20 10 04 13 & CG 20 37 04 13 attached and Auto form 1198 (01/04) attached but only in regards to work completed by named insured for railroad amusement equipment work 130 days notice of cancellation - 10 days for non payment of premium COFC-CO City of Fort Collins Attn: Marisa Donegon 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. Bruce'A. ATIVE ACORD 25 (2016/03) ©1988-2015 ACORD CMP All rights reserved. The ACORD name and logo are registered marks of ACORD ;r