HomeMy WebLinkAboutBENSON ROLL-OFF SERVICES LLC - INSURANCE CERTIFICATE (6).aco CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY)
F2/18/2016
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 CONTACT
Arthur J. Gallagher Risk Management Services, Inc. NAME:PHONE 303-295-1700 _ a .y�: 303-295 2121
700 17th Street, Suite #675 EMAIL )
Denver CO 80202
INSURERISI AFFORDING COVERAGE NAIC •
INSURER A:Pinnacol Assurance Company 141190
INSURED INSURER B: Owners Insurance Company 32700
Benson Rolloff Services, LLC INSURER C : _
6885 Lowell Blvd. INSURER D :
Denver, CO80221 ---- —-
rnvrDanrc rGDTIGIreTr R11111ADrD. 1RQ99nA15Q Dr111cln111 aumeDro.
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.
INR
TIR
TYPE OF INSURANCE
D
POLICY NUMBER
POLICY
% MMiDDY P
LIMITS
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE 17 OCCUR
EACH OCCURRENCE
$
S _
E
SRERTEien--
PREMISES
pREMISES Ea occurrence
MED EXP (An one person)
PERSONAL & ADV INJURY
E
y
GEN'L
AGGREGATE LIMIT APPLIES PER:
POLICY PRO- J LOC
JECT u
OTHER:
GENERAL AGGREGATE
PRODUCTS - COMP/OP AGG
_
E
L
B
AUTOMOBILE
LIABILITY
ANY AUTO
OWNED X SCHEDULED
AUTOS ONLY AUTOS
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
BNED Ea a
E 1,000,000
E
X
BODILY INJURY (Per person)
BODILY INJURY (Per accident)
E
X
PROPERTY DAMAGE
Per accident
E
$1,000,000
Hrd & N Ow Auto
UMBRELLA LIAB
EXCESS LIAB
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
E _
$
AGGREGATE
DED i I RETENTION E
E
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? ❑N
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
N/A
4063853
12/1/2016
12/1/2017
X STATUTE ER
E.L. EACH ACCIDENT
$100,000
E.L. DISEASE - EA EMPLOYEE
$100,000
E.L. DISEASE- POLICY LIMIT
$500,000
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required)
%,r K I Ir 14H I t t1ULUtK L:ANL;LLLA I IUN
City of Fort Collins
PO Box 580
Ft. Collins CO 80522
USA
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
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ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD