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HomeMy WebLinkAboutCUSTOM DISPOSAL LLC - INSURANCE CERTIFICATE (2)C USTO-1 OP IQu MM ,4coRO CERTIFICATE OF LIABILITY INSURANCE DATE (771? Y7Y) 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 970-674-8825 CONTACT Jay W. Helzer Renaissance Insurance Group A P O Box 478 101 E Main Street Windsor, CO 80550 Jay W. Helzer INSURED Custom Disposal, LLC 620 East 3rd Street Eaton, CO 80615 N ME: _ 1 PHONE _„ 970-674-8825 F.A?t .,_._970-674-8826 D: Central Mutual Insurance I I INSURER F : I 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 LTR TYPE OF INSURANCE ADDL SUB POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 7 OCCUR CLP9894897 11/20/2017 11/20/2018 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED rencel,MED $ 300,000 EXP (Any oneperson) 6,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY ❑ JEST LOC OTHER GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMPIOP AGG $ 2,000,000 A AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS AUTOS ONLY AUOTOS ONL� BAP9894900 11/20/2017 11/20/2018 r(Ea accci .rrtS_ INGLE LIMIT $ 1,000,000 $ _ $ $ X BODILY INJURY Per erson BODILY INJURY Per accident Perr. dentDAMAGE UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DIED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YINSTATUTE ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) Byes, describe under DESCRIPTION OF OPERATIONS below NIA PER OTH- ER E.L. EACH ACCIDENT E L DISEASE - EA EMPLOYEE'I E.L. DISEASE - POLICY LIMIT $ $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Fax: 970-221-6782/Attn: Linda Samuelson CITY OF SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Fort Collins PO Box 58 Fort Collins, CO 80522 AUTHORIZED REPRESENTATIVE ,f ACORD 25 (2016103) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD