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HomeMy WebLinkAboutLAMBLAND INC DBA A-1 ORGANICS - INSURANCE CERTIFICATE 2021-2022Pinnacol Assurance 7501 E. Lowry Blvd. Denver, CO 80230-7006 Lambland Inc dba A-1 Organics 16350 Wcr 76 Eaton, CO 80615 05/05/2021 4203555 05/01/2021 05/01/2022 1,000,000 1,000,000 1,000,000 First Choice/InsurSource LLC 2172748 City of Ft Collins Financial Services - Purchasing Division PO Box 580 Fort Collins, CO 80522 jgroves@fcgov.com Unless otherwise stated in the policy provisions, coverage in Colorado only. CERTIFICATE HOLDER COPY City of Ft Collins Financial Services - Purchasing Division PO Box 580 Fort Collins, CO 80522 04/26/2021 Flood and Peterson PO Box 578 Greeley CO 80632 Misty Fiscus (970) 356-0123 (970) 330-1867 MFiscus@floodpeterson.com Lambland, Inc. 16350 CR 76 Eaton CO 80615 Nationwide Mutual Insurance Company Writing Co 23787 Nationwide Agribusiness 28223 CL2142639879 A Y CPP125254A 04/26/2021 04/26/2022 1,000,000 300,000 10,000 1,000,000 2,000,000 2,000,000 Employee Benefits 1,000,000 A Y CPP125254A 04/26/2021 04/26/2022 1,000,000 Medical payments 5,000 B 0 CU125254A 04/26/2021 04/26/2022 5,000,000 5,000,000 The City, its officers, agents and employees shall be named as additional insured on the Service Provider's general liability and automobile insurance policies for any claims arising out of work performed under this agreement. The insurance evidenced by this Certificate will not reduce coverage or limits and will not be cancelled except after thirty (30) days written notice has been received by the City of Fort Collins. City of Fort Collins Attn: Financial Services 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. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME: CONTACT (A/C, No): FAX E-MAIL ADDRESS: PRODUCER (A/C, No, Ext): PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT ER OTH- STATUTE PER LIMITS(MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) POLICY EFF POLICY NUMBERTYPE OF INSURANCELTR INSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY A1 Organics, Inc. Environmental Equipment Company, LLC WJW Properties, LLC Additional Named Insured Additional Named Insured Additional Named Insured Additional Named Insureds Other Named Insureds OFAPPINF (02/2007)COPYRIGHT 2007, AMS SERVICES INC