HomeMy WebLinkAboutBRB CONTRACTORS - INSURANCE CERTIFICATE (2)l his certtticate is executed by Liberty Mutual Insurance Group as respects such insurance as is afforded by those companies. BM0068
Certificate of Insurance
This certificate is issued as a matter of information only and confers no rights upon you the certificate holder. This certificate is not an insurance policy and does not amend, extend, or alter the coverage
afforded by the policies listed below.
Pms is to certify that (Name and address of Insured)
BRB CONTRACTORS INC.
3805 NW 25TH STREET
PO BOX 750940
TOPEKA, KS 66618
is not altered by anv reouirement. term
Ex iration Type
Continuous*
Extended
JX
Policy Term
Workers Compensation
General Liability
HClaims Made
X Occurrence
Retro Date
Automobile Liability
X Owned
X Non -Owned
X Hired
t
to all their terms, exclusions and conditions and
with respect to which this certificate
04/01/2007 / 04/01/2008
WC7-141-433275-017
Coverage afforded under WC law of
the following states:
Employers Liability
Bodily Injury By Accident
$1,000,000 Each Accident
AR, AZ, CO, IA, KS, MN, MO, NE, NM,
OK, SD, TX
Bodily Injury By Disease
$1,000,000 Policy Limit
Bodily Injury By Disease
$1,000,000 Each Person
04/01/2007 / 04/01/2008 I TB2-141-433275-027 I General Aggregate -Other than Prod/Completed Operations
Products/Completed Operations Aggregate
Bodily Injury and Property Damage Liability Per
$1,000,000 Occurrence
Personal and Advertising Injury Per Person /
$1,000,000 Or anizatiot
Other Liability Other Liability
$100,000 Fire Legal $10,000 Medical
04/01/2007 /04/01/2008 1 AS2-141-433275-037 I Each Accident - Single Limit - B. I. and P. D. Combined
Each Person
Each Accident or Occurrence
Each Accident or Occurrence
C
O
M
M
E
N
T
S
*If the certificate expiration date is continuous or extended term, you will be notified if coverage is terminated or reduced before the certificate expiration date. However, you will not be notified annually of
the continuation of coverage.
Special Notice - Ohio: Any person who, with intent to defraud or knowing that he / she is facilitating a fraud against an insurer, submits an application or files a claim containing a false or
deceptive statement is guilty of insurance fraud.
Important information to Florida policyholders and certificate holders: in the event you have any questions or need information about this certificate for any reason, please wntact your local sales producer,
whose name and telephone number appears in the lower left mrcer of this certificate. The appropriate local sales office mailing address may also be obtained by calling this number.
Notice of cancellation: (not applicable unless a number of days is entered below) . Before the stated expiration date the company will not cancel or reduce the insurance afforded under the above
policies until a[ least 30 days notice of such cancellation has been mailed to:
Office: OVERLAND PARK, KS Phone: 913-681-1700
Certificate Holder:
City of Fort Collins
Attn: James O'Neill, Director, Purchasing & Risk Mgmt
215 North Mason Street, 2nd Floor
Fort Collins, CO 80524
CHRISTINA GRAVELY
Date Issued: 03/26/2007 Prepared By- CH