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HomeMy WebLinkAbout119699 GALLEGOS SANITATION INC - INSURANCE CERTIFICATE (14)GALLSAN-01 BADA
ACORO FIDD/YYYY)
017 E (MM
CERTIFICATE OF LIABILITY INSURANCE 0DATE(MM/ DNY
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 have ADDITIONAL INSURED provisions or 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 NAMT�T
PFS Insurance Group
4848 Thompson Parkway Suite 200 AJCC,NNo, Ext): (970) 635-9400 FAX No):(970) 635-9401
Johnstown, CO 80534 _Ms. info@mypfsinsurance.com
INSURED Gallegos Sanitation Inc. GBP, LLC
Services Colorado LLC
Tom Clock
P.O. Box 1986
Fort Collins, CO 80522
INSURER A:
Gallegos INSURER B :
INSURER C :
INSURER D ,
INSURER E .
INSURER F :
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
00
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 I TYPE OF INSURANCE ADDL V4VQ POLICY NUMBER POLICY EFF POLICY EXP LIMITS
INSD WV / MM/
A
X
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
CLAIMS -MADE X OCCUR
ACPGLA03027019089 05/01/2017 i 05/01/2018
DAMAGE TO RENTED
PREMISES Ea o currence
300,000
$
MED EXP (Any oneperson)
$ 10,000
PERSONAL & ADV INJURY
$ 1,000,000
GE_ RL AGGREGATE LIMIT APPLIES PER:
POLICY n inT n LOC
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS -COMP/OP AGG
$ 2,000,000
OTHER:
A
AUTOMOBILE LIABILITY
Ea aBcd 'it, LE LIMIT
$ 1,000,000
$
X ANY AUTO
ACPBAPD3027019089 05/01/2017 05/01/2018 BODILY INJURY Perperson)
$
OWNED SCHEDULED
AUTOS ONLY AUTOS
BODILY INJURY Per accident
$
X HIRED X NON -OWNED
AUTOS ONLY AUTOS ONLY
TnDAMAGE
PROPERTY
i---
$
A
X
UMBRELLA LIAB
X OCCUR
EACH OCCURRENCE
$ 11000,000
EXCESS LIAB
CLAIMS -MADE
ACPCAA3027019089 05/01/2017 05/01/2018 AGGREGATE
$ 1,000,000
DED X i RETENTION $ 0
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE (:
PER OTH-
TAT T R
E.L. EACH ACCIDENT
$
- $
OFFICER/MEMBER EXCLUDED? u
(Mandatory in NH)
N/A
�'E.L. DISEASE - EA EMPLOYE
$
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE -POLICY LIMIT
A Equipment Floater
ACPCIM3027019089 06/01/2017
05/01/2018 Leased 8r Rented
200,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
If required by written agreement, the certificate holder Is included as additional insured for ongoing operations under general liability.
City of Fort Collins Financial Services
Risk Management
215 North Mason Street
Fort Collins, CO 80524
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
ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD