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HomeMy WebLinkAboutCARNES SERVICES - INSURANCE CERTIFICATE (4)5/18/2017 1:56 PM FROM: Fax TO: 2246134 PAGE: 001 OF 001 ACORN® `�. CERTIFICATE OF LIABILITY INSURANCE DATE(MMI)DA-C" 5/4/2016 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 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 Robert Rendon NAME: John C Beckett and Associates Inc A1CrN E (970) 484-2805 FAC No: (970)484-2885 220 Smith Street EMAIL DDRESS: robert@beckettinsurance.com A INSURER(S) AFFORDING COVERAGE NAIC 4• INSURERA:FIRST MERCURY INSURANCE COMPANY Ft. Collins CO 80524 _ INSURED INSURERS Artisan b Truckers Casualty Co 10194 INSURER : Carnes Services Corporation PO BOX 1258 INSURER D INSURER E : Wellington CO 80549 INSURER F : CUVEKAUE5 CERTIFICATE NUMBER:UL1t)n4U.LZ45 REVISION Nt1MRFR- 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. LTR TYPE OF INSURANCE ADOL POLICY NUMBER MMIDOIYEYYY POLICY EXP MMIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Ex_] OCCUR BLANKET ADDL INSD VA-CGL0000063788-02 4/28/2017 4/28/2018 EACH OCCURRENCE $ 1,000,000 PREMISES Ea occurrence $ 5,0000 X MED EXP (Any one person) $ EXCLUDED X BLANKET WAIVER 6 PNC PERSONAL &ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY [�] PJE'C)T- 7 LOC OTHER GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OPAGG $ 2,000,000 $ B AUTOMOBILE LIABILITYIN ANY AUTO ALL OWNED X SCHEDULED AUTOS AUTOS HIRED AUTOS X AUTOS ED 03041981-3 5/1/2017 5/1/2018 -INGLEL IMI Eaaccident $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ X PROPERTY Per accidentDAMAGE $ A UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE CAEX0000063768-02 4/28/2017 4/28/2018 EACH OCCURRENCE $ 1,000,000 N AGGREGATE $ 1,000,000 DEC X RETENTION$ 10,000 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y f N ANY PROPPIETOP(PARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A AO COVERAGE PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L DISEASE - EA EMPLOYEE $ E L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) (970)224-6134 CITY OF FORT COLLINS STREET DEPARTMENT P.O. BOX 580 FORT COLLINS, CO 80522 GANI LLA I IUN 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 T ._ ='K-r; LIND _` © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (201401)