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HomeMy WebLinkAbout129302 HAGEMAN EARTH CYCLE - INSURANCE CERTIFICATE (17)ACC> OR ® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 11 9/27/2017 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 Brlanne Danielson CISR NAME: r Flood and Peterson PHONE (g70)266-7118 FAX AIC o A/C No:(970)506-6846 Corporate Mailing Address: E-MAIL BDanielson@F1oodPeterson.com ADDRESS: P.O. Box 578 INSURERS AFFORDING COVERAGE NAIC # Greeley CO 80632 INSURERA.Union Insurance Company 25844 INSURED INSURERB:Pinnacol Assurance 41190 Hageman Earth Cycle, Inc. 3501 E. Prospect Road Fort Collins CO 80525 1 INSURERF: COVERAGES CFRTIFICATF NIIMRFP-CLI792719714 179=I/ICInKI NII IILl 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. INSR7 LTR TYPE OF INSURANCE ADDL J= UBR WVD POLICY NUMBER POLICY EFF MWDD/YYYY) POLICY EXP (MMIDD/YYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY � CLAIMS -MADE I X OCCUR EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence)$ 300,000 X MED EXP (Any one person) $ 10,000 $500 Deductible - CPA 2344893-35 12/01/2016 12/01/2017 Property Damage PERSONAL BADVINJURY $ 1,000,000 AGGREGATE LIMIT APPLIES PER: POLICY D PRO LOC JECT GENERAL AGGREGATE $ 2,000,000 GENT X PRODUCTS -COMP/OP AGG $ 2,000,000 $ OTHER. AUTOMOBILE LIABILITY CEOMaB`NdEDt SINGLE LIMIT $ 1,000,000 BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS CPA 2344893-35 12/01/2016 12/01/2017 BODILY INJURY (Per accident) $ X HIRED AUTOS $ AUTOS NON -OWNED PROPERTY t DAMAGE Per accden $ Medical Payments $ 5,000 X UMBRELLA LIAB X i OCCUR EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 A EXCESS LIAB CLAIMS -MADE DED RETENTION$ $ ICPA 2344893-35 12/01/2016 12/01/2017 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N 'ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) i If yes, describe under NIA 4036218 10/01/2017 10/01/2018 X PER OTH- STATUTE I ER E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYE $ 500L000_ ----- - — - _— E.L. DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS below $ 500,000 A Leased/Rented Equipment CPA 2344893-35 12/01/2016 12/01/2017 Limit $230,000 Deductible $1 , 0 0 0 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate holder is included as Additional Insured as required by written contract with respects to liability arising out of work performed by the named insured. I.CR 1 Ir i%,A 1 C PIULL)CI[ I:AIVGtLLA I IUN City of Fort Collins P.O. Box 580 Fort Collins, CO 80522 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 B Danielson, CISR/BDA V- " ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 rgm4ni 1