HomeMy WebLinkAbout107133 BATH INC - INSURANCE CERTIFICATE (15)A� O® CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
10/26/2017
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
Flood and Peterson
PO Box 578
Greeley CO 80632
CONTACT NAME: Jennifer Winter CISR
PHONE (970)506-3206 A/CNo:(970)506-6846
ADDRESS:JWinter@floodpeterson.com
INSURERS AFFORDING COVERAGE
NAIC #
INSURERA:Union Insurance Company
25844
INSURED
Bath, Inc.
2000 E . Prospect Road
,Fort Collins CO 80525
INSURER B :Pinnacol Assurance
41190
INSURERC:
INSURER D :
INSURER E :
INSURER F :
COVERAGES CERTIFICATE NUMBER:CL17102620280 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
ADD
UBR
POLICY NUMBER
MM%ODIYYYY
MMIDDnYYY
LIMITS
X
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
A
CLAIMS -MADE �X OCCUR
RENTED
PREM SES� a occurrence
$ 300 , 000
X
MED EXP (Any one person)
$ 10,000
PD Ded: 500
CPA315208421
11/1/2017
11/1/2018
PERSONAL & ADV INJURY
$ 1,000,000
GENT AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS - COMP/OP AGG
$ 2,000,000
POLICY PE� LOC
$
OTHER:
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
Ea accident
$ 1,000,000
BODILY INJURY (Per person)
$
A
X ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
NON -OWNED
X HIRED AUTOS X AUTOS
CPA315208421
11/1/2017
11/1/2018
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
Peraccident
$
$
X Drive Other Car
X
UMBRELLA LIAB
X
OCCUR
EACH OCCURRENCE
$ 5 000 000
AGGREGATE
$ 5,000,000
A
EXCESS LIAR
CLAIMS -MADE
DED I X I RETENTION$ 0
$
CPA315208421
11/1/2017
11/1/2018
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y/N
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? (Mandatory in NH)
N/A
4015110
11/1/2017
11/1/2018
X STATUTE ERH
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYE
$ 1 000 000
E.L. DISEASE - POLICY LIMIT
1 $ 1,000,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
RE: Arborist License
(;tK I It II:A It MULUtK %,MIYVCLLM I IVry
City of Fort Collins
PO Box 580
Fort 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
J Winter, CISR/JWINTE
ACORD 25 (2014/01)
INS025m1401i
U 1988-2014 ACORD CORPORATION. All rlgnts reservea.
The ACORD name and logo are registered marks of ACORD