Loading...
HomeMy WebLinkAbout102606 4 RIVERS EQUIPMENT LLC - INSURANCE CERTIFICATE (5). i*_ R' CERTIFICATE OF LIABILITY INSURANCE �, DATE D/YYYY) oa/1 s/eon 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 CONSTITU)'E 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 NAME: Sentry Customer Service Sentry Insurance Company PHONE FAX 1800 North Point Drive A/C No Ex : 800-473-6879 IACNo: 868-533-7827 EMAIL ADDRESS: busine« roducts ssdod' .com Stevens Point, WI 54481 INSURER(S) AFFORDING COVERAGE NAIL k INSURER A: SENTRY SELECT INSURANCE COMPANY 21180 INSURED INSURER B : 4 RIVERS EQUIPMENT LLC 1100 E CHEYENNE RD INSURER C : INSURER D : COLORADO SPRINGS, CO 80905 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 0719 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, INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF M/DD POLICY EXIP M/DD LIMITS q X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Xl OCCUR 24-72581-01 09/01/2017 09i01/2018 EACH OCCURRENCE $ 500,000 DAMAGE TO RENTED PREMISES a occurrence` $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 500,000 GEN'L AGGREGATE LIMIT APPLIES PER, POLICY ❑JECTPRO ❑ LOC OTHER: GENERAL AGGREGATE $1,500,000 X PRODUCTS - COMP/OP AGG $ 1,500,000 $ A AUTOMOBILE LIABILITY ANY AUTO ALLNED AUTOESULED HIRED AUTOS NON -OWNED AUTOS 24-72561-01 09/01/2017 09/01/2018 COMBINED SINGLE LIMIT a acc den ` $ 500,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident, $ PROPERTY DAMAGE (Per accident $ A X UMBRELLA LIAR EXCESS LIA13 N OCCUR CLAIMS -MADE 24-72581-01 09/01/2017 09/01/2018 EACH OCCURRENCE $ 20,000,000 X AGGREGATE $ 60,000,000 DED RETENTION $ PRODUCTS - COMP/OP AGG $ 60,000,000 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/E)(ECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CITY OF FORT COLLINS 300 LAPORTE AVE FORT COLLINS, CO 80521 CANCELLATION 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 REPRESENTATIVES 47 � n 14a_ r ` ACORD 25 (2014/01) 2472581 0719 1 00001 0000001556 17228 0 N Page 1 of 2 01988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 08/15/2017 D5A06D4E-2F1B-4858-6744-AE14055FCBE2 ACORO® AGENCY Sentry Insurance Compa POLICY NUMBER 24-72581-01 CARRIER AGENCY CUSTOMER ID: LOC #: — ADDITIONAL REMARKS SCHEDULE NAMED INSURED 4 RIVERS EQUIPMENT LLC NAIC CODE EFFECTIVE DATE: 09/01 /2017 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liabil tv Insurance Page 2 of 2 ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. 2472581 The ACORD name and logo are registered marks of ACORD 08/15/2017 A4COR6r CERTIFICATE OF LIABILITY INSURANCE ��- DAT5/2017 D/YYYY) oan /2o17 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 NAME: Sentry Customer Service Sentry Insurance Company PHONE FAX 1600 North Point Drive A/C No Ex : 800-473-6879 A/C No): 668-533-7827 EMAIL Stevens Pant, WI 54481 ADDRESS: businessproducts ssdckVsen .corn INSURER(S) AFFORDING COVERAGE NAIC M INSURER A: SENTRY SELECT INSURANCE COMPANY 21180 INSURED INSURER B : 4 RIVERS EQUIPMENT LLC 1100 E CHEYENNE RD INSURER C INSURER D : COLORADO SPRINGS, 00 80905 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 0719 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. INSR LTR TYPE OF INSURANCE ADDL INSR SUER WVD POLICY NUMBER POLICY EFF M/DD POLICY EXP M/DD LIMITS CLAIMS -MADE OCCUR EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY 7 PRO JECT ❑ LOC OTHER: GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $ A AUTOMOBILE LIABILITY ANY AUTO ALL AUTOS OWNED AUTOS SCHEDULED HIRED AUTOS NON -OWNED AUTOS 24-72581-03 09/01/2017 09/01/2018 COMBcINED SINGLE LIMIT (Ea acdent` $ 500,000 X BODILY INJURY (Per person) $ BODILY INJURY Per accident) $ PROPERTY DAMAGE (Per accident' $ A X UMBRELLA LIAR EXCESS LIAR H OCCUR CLAIMS -MADE 24-72581-01 09/01/2017 09/01/2018 EACH OCCURRENCE $ 20,000,000 X AGGREGATE $ 60,000,000 DED I I RETENTION $ PRODUCTS - COMP/OP AGG $ 60,000,000 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A OH - TUTE EE R STATUTE E.L. EACH ACCIDENT $ E.L. DISEASE - FA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION CITY OF FORT COLLINS 300 LAPORTE AVE 'ORT COLLINS, CO 80521 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 (2014/01) 2472581 0719 1 00001 0000001557 17228 0 N Page 1 of 2 O 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 08/15/2017 267C2516-052F-4D45-BBOE-5ABFE4513E64 ACORO® AGENCY Sentry Insurance Compaq POLICY NUMBER 24-72581-03 CARRIER AGENCY CUSTOMER ID: LOC #: — ADDITIONAL REMARKS SCHEDULE NAMEDINSURED 4 RNERS EQUIPMENT LLC NAIC CODE EFFECTIVE DATE: 09/01/2017 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, I FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Page 2 of 2 ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. 2472581 The ACORD name and logo are registered marks of ACORD 08/15/2017 , 1*_ R' I® CERTIFICATE OF LIABILITY INSURANCE � DATE2017 /YYYY) esn s/o17 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 NAME: Sentry Customer Service Sentry Insurance Company PHONE FAX 1800 North Point Drive A/C No Ex : 800-473-6879 A/C No: 868-533-7827 EMAIL Stevens Point, WI 54481 ADDRESS: busine roducts ssdotOsentry.corn INSURER(S) AFFORDING COVERAGE NAIC M INSURER A: SENTRY SELECT INSURANCE COMPANY 21180 INSURED INSURER B : 4 RIVERS EQUIPMENT LLC 1100 E CHEYENNE RD INSURER C : INSURER D : COLORADO SPRINGS, CO 80905 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 0719 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. INSR LTR TYPE OF INSURANCE ADDL INSR SUER WVD POLICY NUMBER POLICY EFF M/DD POLICY EXP M/DD LIMITS CLAIMS -MADE OCCUR EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES /Ea occurrence $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'LAGGREGATE LIMIT APPLIES PER : POLICY ❑ PRO ❑ LOC JECT OTHER: GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $ A AUTOMOBILE LIABILITY ANY AUTO ALTOWNED SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS 24-72581-17 09/01/2017 09/01/2018 COMBINED SINGLE LIMIT n .dntI $ 500,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accide $ A X UMBRELLA LIAB EXCESS LIAB H OCCUR CLAIMS -MADE 24-72581-01 09/01/2017 09/01/2018 EACH OCCURRENCE $ 20,000,000 X AGGREGATE $ 60,000,000 DED I I RETENTION $ PRODUCTS - COMP/OP AGG $ 60,000,000 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A PER OTH- STATIIfE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CITY OF FORT COLLINS 300 LAPORTE AVE FORT COLLINS, CO 80521 CANCELLATION 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 (2014/01) 2472581 0719 1 00001 0000001558 17228 0 N Page 1 of 2 01988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD E53E4A7E-637D-427F-94D8-A888A55F480F 08/15/2017 AC"RL> AGENCY Sentry Insurance Compaq POLICY NUMBER 24-72581-17 CARRIER AGENCY CUSTOMER ID: LOC #: — ADDITIONAL REMARKS SCHEDULE NAMED INSURED 4 RNERS EQUIPMENT LLC NAIC CODE EFFECTIVE DATE: 09/01 /2017 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liabil tv Insurance Page 2 of 2 ACORD 101 (2008/01 ) © 2008 ACORD CORPORATION. All rights reserved. 2472581 The ACORD name and logo are registered marks of ACORD 08/16/2017