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Home My WebLink About253179 GRAFFITTI'S INC DBA MIKE'S HAULING & CLEANU - INSURANCE CERTIFICATE (3)From:Pat Rowe FaxID: Page 1 of 1 Date:12/2912016 01:10 PM Page:1 of 1 -� MIKES-1 OP ID: P6 ACOROF DATE (MMIDDNYYY) �,- CERTIFICATE OF LIABILITY INSURANCE 1 12/29/2016 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 endorsement(s). PRODUCER CONTA Brown Brown Inc NAME: House Account 4532 Boardwalk Dr, Suite 200 A1CNNo E :970-482-7747 A!C No: 970-484-4165 Fort Collins, CO 80525 E-MAIL House Account ADDRESS: INSURED U!' ilTlttl 5, InG. U10d. IVIIKU S Hauling & Cleanup Service PO Box 7634 Loveland, CO 80537-0634 r�Til11 �-7.rei �� rFRT1G1rATF MI IMRFR- INSURERS) AFFORDING COVERAGE NAIC 0 INSURERA:Midwest Family Mutual Ins Co 23574 INSURER13:Pinnacol Assurance Company INSURER C : 41190 INSURER D : IN SURER E : INSURER F : RFVISION NLIMRFR- 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 TYPE OF INSURANCE INSD WVO POLICY NUMBER MM1DD/YYYY MMIDDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR CPCO0560 113426 12/11/2016 12/11/2017 EACH OCCURRENCE $ 1,000,000 PREMISES Ea occurrence $ 50,000 MED EXP (Any one person) $ 5,000 PERSONAL &ADV INJURY S 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: POLICY ❑ JECT LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS- COMPIOP AGG $ 2,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED X SCHEDULED AUTOS AUTOS NON -OWNED X HIRED AUTOS X AUTOS CPCO0560 113426 12/11/2016 12/11/2017 COMBINED SINGLE LIMIT Ea acddent $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Peraccident $ UMBRELLA LAB EXCESS LAB HCLAIMS-MADE OCCUR EACH OCCURRENCE $ AGGREGATE $ DIED 7 RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIEFORIPARTNERIEXECUTIVE YIN OFFICEWMEMBER EXCLUDED') ❑ (Mandatory in NH) f YYes describe under DES RIPTION OF OPERATIONS below NI A 4007823 01/0112017 01/01/2018 X PER OT.- STATUTE ER E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 E.L. DISEASE -POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) FAX: 970-221-6782 rLRTIGIrATG uni nFR C_ANC_FI I ATION CITYFT2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS. Purchasing AUTHORIZED REPRESENTATIVE Sales Tax Division 281 N. College SAY .Fort Collins, CO 80521 V 1y66-LU14 At.UKU t.UKVUKA 1IUN. All rlgnts reserves. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD