HomeMy WebLinkAbout4012 Builders LLC - Insurance Certificate ACOROa DATE(MMiDDNYYY)
AC� CERTIFICATE OF LIABILITY INSURANCE F2r6/2025
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 C NTACT
NAME: Kelly Muse
IMA Select LLC PHONE 720 901-4123 i A No:
2721 Council Tree Ave E-MAIL
Suite 218 ADOREss: kell .muse imacor .com
Fort Collins CO 80525 INSURERS AFFORDING COVERAOE NAIC#
License#._PC-1115916 INSURER Selective Insurance Company of South Carolina 19259
INSURED 4012SUI-01 INSURER B: Pinnacol Assurance 41190
4012 Builders LLC INSURERC:
4012 Cherry Hills Drive
Fort Collins CO 80524 INSURERD:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER:1481647842 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 - ;ADDL SUBR - _ _ POLICY EFF POLIppY EXP. -
LTRI TYPEOFINSURANCE :IN D:WV POLICY NUMBER MWDD/YYYY MMlDD/YYYY LIMITS
A X COMMERCIAL GENERAL LABILITY ! S 2563070 1/6/2025 ! 1/6/2026 ! EACH OCCURRENCE $1.000.000
DAMAGE TO RENTED 500,000
CLAIMS-MADE X OCCUR PREMISES(Ea occurrence $
—. — --
MED EXP(Any one person) $15,000
PERSONAL&ADV INJURY $1.000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000.000
X I POLICY PRO- LOC I 'LPRODUCTS-COMP/OP AGG $3,000,000
�—;JECT
OTHER: $
A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
_ S 2563070 1l6/2025 1/6/2026 $1.000.000
X ANY AUTO BODILY INJURY(Per person) $
OWNED —;SCHEDULED I BODILY INJURY(Per accident) $
!AUTOS
X HIRED AUTOS ONLY X NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY I_LPer accident)
$
A X UMBRELLALIAB j X ! OCCUR S 2563070 1/6/2026 1/6/2026 EACHOCCURRENCE $1,000.000
EXCESS UAB j CLAIMS-MADE AGGREGATE $1,000,000
DED ! X ! RETENTION$n $
B WORKERS PER
AND EMPLOYEMPENSATN RS'L ABILI Y 4255588 12l1812024 1/1/2026 X STATUTE ORH
Y/N
ANYPROPRI ETOW PARTNER/EXECUTIVE
OFFICER/MEMBEREXCLUDED? Y N(A _E.L_EACH ACCIDENT $1,000,000
(Mandatory In NH
E.L.DISEASE-EA EMPLOYEE $1,000,000
11 yes,describe under —
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000
I
DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required)
Workers Compensation Information: Proprietors/Partners/Executive Officers/Members Excluded:subject to the policy terms and conditions.
CERTIFICATE HOLDER 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.
City of Fort Collins
281 N College Ave AUTHORIZED REPRESENTATIVE
Fort Collins CO 80524
01988-2015 ACORD CORPORATION, All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
5246: 2 ' of 2