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HomeMy WebLinkAbout119699 GALLEGOS SANITATION INC - INSURANCE CERTIFICATE (13)Client#: 1083457 GALLESAN ACORD,CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDYYYY) 6/13/2017 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 Client Manager NAME USI Colorado, LLC C/L PHONE : 800 873-8500 (vc No): 303 831-5295 Englewood, CO 80155 DD P.O. Box 7050 AD -DRESS: den.certificate@usi.com INSURER(S) AFFORDING COVERAGE NAIC # 800 873-8500 INSURERA: Pinnacol Assurance Company 141190 INSURED Gallegos Sanitation, Inc. PO Box 1986 Fort Collins, CO 80522 INSURER B : INSURER C : INSURERD: INSURER E : INSURER F : C0VFRAnFR rI=RTICIrATF nlllneMMO- 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 ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MM/DD POLICY EXP MM/DD LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR EACH OCCURRENCE $ $ AM AGE TO RENTED PREMISES Ea occurrence MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: IE GENERAL AGGREGATE $ POLICY I CO T LOC PRODUCTS - COMP/OP AGG $ $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident BODILY INJURY (Per person) _ $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ NON -OWNED HIRED AUTOS AUTOS $ PROPERTY DAMAGE Per accident $ UMBRELLA LIAR HCLAIMS-MADE OCCUR EACH OCCURRENCE $ AGGREGATE EXCESS LIAR _ $ DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBEREXCLUDED? 7N N/A X 4148231 6/01/2017 06/01/201 X PER OTH- E.L. EACH ACCIDENT $1OOO OOO E.L. DISEASE - EA EMPLOYEE $1 000 000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below _ E.L. DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The Workers Compensation Policy provides a Blanket Waiver of Subrogation when required by written contract, except as prohibited by law. City of Fort Collins Financial Services Risk Management 215 N. Mason St. 2nd FI;PO Box 580 Fort Collins, CO 80522-0000 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 �C ACORD 25 (2014/01) 1 of 1 #S20688079/M20686812 ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AKTZP