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HomeMy WebLinkAboutB H Inc. - Insurance Certificate 2024 i A�® DATE(MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE F3/18/2024 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 CONTACT NAME: Frank Rutkowski _ CSDZ, LLC PHONE ! FAX 132 South State St .612-349-2431 ! (A/C,No): Salt Lake City LIT 84111 ADDRESS: frutkowski@holmesmurphy.com INSUREfl S AFFORDING COVERAGE NAIC# INSURER A:Zurich American Insurance Company 16535 INSURED BHINCI INSURER B: Navigators Insurance Company 42307 B H Inc. 1175 East 2000 South INsuRERc: Illinois Union Insurance Company 279ti0 Vernal, LIT 84078 _ omparfy_______ _INSURER_o__Midvale Indemnity Com anfir_ i, INSURER E: Berkley Insurance Company 32603 INSURERF: RSUI Indemnity Company 22314 COVERAGES CERTIFICATE NUMBER:2070352142 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. INSRI - TYPE OF INSURANCE ;ADDUSUBR' POLICY EFF-` POLICY EXP LTR IN D'WV POLICY NUMBER MM/DDIYYYY MMDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY GLO011032804 j 4/l/2024 1 4/1/2025 ' EACH OCCURRENCE $2,000,000 -I A AG ORE T CLAIMS-MADE i X j OCCUR I {PREMISES( a occurrence) $50,000 X 25,000 I I MED EXP(Any one person) $5,000 X Policy ForrNXCU PERSONAL&ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000 X PR X POLICY PR LOC PRODUCTS-COMP/OPAGG $4,000,000 X Ri is Limit OTHER: Riggers $$1,000,000 A AUTOMOBILE LIABILITY BAP011032904 4/112024 4/1/2025 COMBINED SINGLE LIMIT $2,000,000 X ANY AUTO BODILY INJURY(Per person) $ OWNED iI SCHEDULED j BODILY INJURY(Per accident) $ AUTOS ONLY i AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY �_{Per_accident)___ X 11 Comp:$1,000 X 1 Cou $1,000 I Hired Auto Phys Dmg $ACV of Vehicle B X UMBRELLA LIAB X GA24EXCZ05KYMIV i 4/112024 4/112025 EACH OCCURRENCE $50,000.000 OCCUR MADE CXP00387202 j 4/1/2024 4/1/2025 P X ; EXCESS LIAR CLAIMS NHA107139 4/1/2024 4/1/2025 AGGREGATE $50,000,000 L�— ---— ------- DED RETENTION$ i q WORKERS COMPENSATION WC011032704 i 4/1/2024 4/112025 X gTATUTE ERH AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETORiPARTNER/EXECUTIVE N I E.L.EACH ACCIDENT $2,000.000 OFFICE R/M EMBER EXCLUDED7 N/ (Mandatory In NH) I E.L.DISEASE-EA EMPLOYEE $2,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE•POLICY LIMIT $2,000,000 C Pollution Liability Per Occur CPYG27847705009 4/1/2024 4/1/2025 $t0.000.00010ccur $10,000,000/Aggr E Professional Liab,Claims-Made PCAB50244700424 4/1/2024 4/1/2025 $10.000.000/Claim $10,000,000/Aggr Rehoactve Date 11/08/2010 i DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Includes Stop Gap for Wyoming 8.North Dakota Employment Practices Liability Coverage-Limit$2,000,000 Pollution Liability Includes Auto-Sudden and Nonsudden are both included. Installation Floater- UM00088938MA24A 4/1/2024-411/2025-Aggregate Limit$1,500,000 Deductible:$1000- XL Specialty Insurance Unmanned Aircraft-GLO011032804 4/1/2024-4/1/2025-Limit$1,000,000 Property-Special Form#UM00088938MA23 4/1/2024-4/1/2025 4th Layer Umbrella-XSL394430GOO 02/19/2024-04/01/2025 5th Layer Umbrella-03141844-02/2212024-04/01/2025 See Attached... 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 North College Ave AUTH RIZEDRfEPRES�ENNTTA/TIIVVE Fort Collins CO 80524 I 01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD 3182: 2 - of AGENCY CUSTOMER ID: BHINCI LOC#: ACCORD® ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED CSDZ, LLC B H Inc. 1175 East 2000 South POLICY NUMBER Vernal, UT 84078 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE 6th Layer Umbrella-ELD30054105500-02/22/2024-02/22/2025 All Work Performed. ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 3182: 3 ' of 3