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HomeMy WebLinkAbout462834 FOOTHILLS LANDSCAPE MAINTENANCE LLC - INSURANCE CERTIFICATE (8)FHLAN-1 OP ID: JD ACORD' CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 03/03/2017 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 Brown &Brown Inc 4532 Boardwalk Dr, Suite 200 CONTANAME: CT Jody Wagner PHONE 970-482-7747 FAX 970-484-4165 A/C No Ext : Arc, No E-MAIL ADDRESS: jwagner@bbcolorado.com 9 @ Fort Collins, CO 80525 Tyler B. Allen INSURER(S) AFFORDING COVERAGE NAIC 9 INSURER A: Pinnacol Assurance Company 41190 INSURED Foothills Landscape Maintenance, LLC P. O. Box 189 INSURER B: AMCO Insurance Company 19100 INSURER C : Nationwide Mutual Fire Ins Co. 23779 INSURER D : Windsor, CO 80550-0189 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 LTR TYPE OF INSURANCE UB POLICY NUMBER MMl DIYYYY FF POLICY M/LD /YYYY LIMITS B X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE 1XI OCCUR X ACPGLA03027035176 04/01/2017 04/01/2018 $ 100,000 DAMAGTE E�ESO aEoccurrence MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,00 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE I $ 2,000,00 POLICY X JE � LJ LOC PRODUCTS -COMP/OP AGG $ 2,000,00 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,00 BODILY INJURY (Per person) $ C X ANY AUTO X ACPBA3027035176 04/01/2017 04/01/2018 ALL OWNED SCHEDULED ��I AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Peraccident $ NON -OWNED HIREDAUTOS AUTOS X UMBRELLA LAB X OCCUR EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,00 B EXCESS LAB CLAIMS -MADE ACPCAA3027035176 04/01/2017 04/01/2018 DIED I X I RETENTION $ 0 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N❑N OFFICER/MEMBER EXCLUDED? (Mandatory in NH) NIA 4154852 04/01/2017 04/01/2018 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEd $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS oelow E.L. DISEASE - POLICY LIMIT 1 $ 1,000.000 B Equipment Floater ACPCIM3027035176 04/01/2017 04/01/2018 Lsd/Rtd 75,000 Ded 1,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The certificate holder is included as an additional insured per forms and conditions shown on page 2. CERTIFICATE HOLDER CANCELLATION CITYFC2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 580 IVE AUTHORIZED REPRESENTATIVE Fort Collins, CO 80522 Wa — `Q. , ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD FHLAN-1 NOTEPAD INSURED'$ NAME Foothills Landscape OP ID: JD The following apply when required by contract: RAL LIABILITY: tional Insured On -going & Completed Operations CG7246 11/15 ary/Non-Contributory Wording CG7246 11/15 ket Waiver of Subrogation CG7323 12/14 Project Aggregate CG7323 12/14 MOBILE LIABILITY: tional Insured On -going Operations AC0102 03/10 ket Waiver of Subrogation AC 0101A 03/10 RELLA LIABILITY: lowing form ' COMPENSATION: Waiver of Subrogation 359-B PAGE 2 Date 03/03/2017