HomeMy WebLinkAbout361699 ZAK GEORGE LANDSCAPING - INSURANCE CERTIFICATE (6)AC+C>R" CERTIFICATE OF LIABILITY INSURANCE
DATE (MM,'DD!YYYY)
3/15/2017
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
CONTACT K lie Care CISR
NAME: y y,
Flood and Peterson
jjPHONo._E�ttIL.(970)266-7148 (AX AQ,,No) (970)506 6845
PO Box 578
E-MAIL
ADDREss:KCarey@floodpeterson.com
_
INSURER(S) AFFORDING COVERAGE NAIC #
1 INSURER A: Cincinnati Insurance Co I10677
Greeley CO 80632
----------------- INSURED
INSURER INSURER B Pinnacol Assurance ? 41190
Zak George Landscaping, LLC
INSURERC._...........................................—'--..-_... .................................. _....... _...... _........ _........................................ ............ _... -- -' -- ............
335 S Summit View Drive
INSURER,D: ..._................
.._.. _....... --....__..-.__.._......_.......................................................... __........................ .�.._..._-..-....
INSURER. ......................................................... ._._......_........... .................................................. __...._.._...__.._._....._.•..................
Fort Collins CO 80524
INSURERF:
CnVFRAGFS CERTIFICATE NUMBER :CL1731516672 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.
ILTR 1 TYPE OF INSURANCE ' N DL U D POLICY NUMBER
LTR r
MMIDfl YYYY MM 00 YYYY LIMITS
X 1 COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE $
1_ D00 000
A CLAIMS -MADE OCCUR
DAMAGE TO RENTED
PREMIbE5.tEaoccurrence}„_„ _$
500,000
..-
X i PD Ded._.: $1, 000 CPP1486294
.........................
4/1/2017 4/1/2016 MED EXP (Any one person) [ $
.... ......
........ ... 10,000
..
I
PERSONAL& ADV INJURY Is
1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE _ $
2,000,000
X POLICY j JEC LOG
PRODUCTS • CCMROP AGG I $
_
2,000,000
OTHER:
WYSG $
1,000,000
`s AUTOMOBILE LIABILITY
` COMBINED SINGLE LIMIT $
i (Ea accident)
1,000,000
X ` ANY AUTO
BODILY INJURY (Per person) $
A
_
ALL OWNED SCHEDULED CPP1086299
4/IJ2027 4J1J2018 ! BODILY INJURY (Per accident) $
AUTOS
— NON -OWNED
X ; HIRED AUTOS X AUTOS
PROPERTY DAMAGE $
(Per acadentj.................................
{ is
Medical payments
5,000
}(,UMBRELLA LIAB X `OCCUR €
( EACH OCCURRENCE is
--
5, 000, 000
_
A EXCESS LIAR CLAIMS MADE
i AGGREGATE ` $
-
5, 000, 000
DED RETENTION CPP1086294
4/1/2017 4/1/2018
WORKERS COMPENSATION
X PER H
STATUTE ER
PTA
AND EMPLOYERS' LIABILITY
q
ANY PROPRIETOR.PARTNERiEXECUTIVE �
E L EACH ACCIDENT t$
1,000 000
uFrii.tR-1AEMliER E xGLUDN iINI 4103537
in NH)II
4/1/2017 I 4/1/2018E.L DISEASE EA EMPLOYE(Mandatory
yP.S deMcnbe under`DESCRIPTION OF OPERATIONS below
E.L. DISEASE -POLICY LIMIT `. $
1,000,000
A Leased/Rented Equipment CPP1086294
4/1/2017 4/1/2018 $50,000Gn;it
$2,500 Deducttb:e
DESCRIPTION OF OPERATIONS i LOCATIONS; VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more space is required)
Certificate holder is included as Additional Insured as
required by written contract with respects to
liability arising out of work performed by the named insured, with respect to the General Liablity and
Auto Liability policies.
f^CQTICIr ATC uni nrzo rAN(':FI_ L ATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
The City of Fort Collins
Purchasing Department
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
P.O. Box 580
AUTHORIZED REPRESENTATIVE
Fart Collins, CO 80522
x Ceixey, c ISR/KCAREY f —.. `
ACORD 25 (2014/01)
INS025 r�)ni4r i
U 19BU-2014 AGUHU GUHNUHA I IUN. AN rlgnts reserves.
The ACORD name and logo are registered marks of ACORD