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HomeMy WebLinkAboutCOMMERCIAL GLASS - INSURANCE CERTIFICATEPolicy Number: Date Entered: 5/4/2007 ACORDL CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) PRODUCER Ainslie Insurance Agency, Inc. 929 38th Avenue Ct. #101 Greeley, CO 80634 (970)353-8917 07-04-Q67 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED Commercial Glass, Inc. Ms Janice L. Montrose 5739 Boeing Drive Loveland, CO 80538 INSURERA:Mid Century Insurance Company INSURERB:Truck Insurance Exchange INSURER C' INSURER D: INSURER E. COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TR ADD' POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A COMMERCIALGENERAL LIABILITY 04595-36-02 5/5/2007 5/5/2008 DAMAGE TRENTED PREMISES Ea occurence 100,000 S r CLAIMSMADE OCCUR MED EXP (Any one person) $ 5,000 PERSONAL B ADV INJURY $ 1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 POLICY PROJEC LOC AUTOMOBILE LIABILITY INGLELIMIT $1,000,000 A ANYAUTO 04595-36-02 5/5/2007 5/5/2008 Eaaaccdeent;INED BODILY INJURY ALL OWNED AUTOS SCHEDULED AUTOS (Per person) $ A HIRED AUTOS O4595-36-02 5/5/2007 5/5/2008 A NON -OWNED AUTOS O4595-36-02 5/5/2007 5/5/2008 BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EAACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY: AGG EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 4,000,000 OCCUR CLAIMS MADE AGGREGATE $ 4,000,000 B 04595-36-03 5/5/2007 5/5/2008 $ $ DEDUCTIBLE RETENTION $10 r 000 $ WORKERS COMPENSATION AND Xj WC STATU- I I OTH- EMPLOYERS' LIABILITY 500,000 A ANY PROPRIETOR/PARTNER'EXECUTIVE 0409-19-08 1/1/2007 1/1/2009 E. L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? E.L. DISEASE EA EMPLOYEE $ 500,000 If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Building Department City of Fort Collins P.O. Box 580 Fort Collins, CO 80522-0580 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO 50 SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ins le I'r'FG�:� � 4rhK4T/e.G At,UKII ZO (ZUUT/Vt$) Produced using Forms Boss Plus software. w .FormsBoss.com; Impressive Publishing 800-208-1977 © ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). IdF-101WI1TiTT7 The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. AGUKU ZO (Zuullu9) Policy Number: Date Entered: 5/4/2007 ACORD,� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YVYY) PRODUCER Ainslie Insurance Agency, Inc. 929 38th Avenue Ct. #101 Greeley, CO 80634 (970)353-8917 07-04-Q67 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED Connercial Glass, Inc. Ms Janice L. Montross 5739 Boeing Drive Loveland, CO 80538 INSURERA:Mid Century Insurance Company INSURERB:Tr ck Insurance Exchange INSURER C: INSURERD: INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR ADD' INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A COMMERCIALGENERALLIABILITY 04595-36-02 5/5/2007 5/5/2008 DAMAGE REN PREMISES Ea occuronce $ 100,000 CLAIIAS MADE 1XI OCCUR MED EXP (Any one person) $ 5,000 PERSONAL B ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 17 POLICY XMOL LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 x A ANY AUTO 04595-36-02 5/5/2007 5/5/2008 (Ea accident) $ BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ A A HIRED AUTOS NON-OWNEDAUTOS O4595-36-02 O4595-36-02 5/5/2007 5/5/2007 5/5/2006 5/5/2008 PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY: AGG EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ 4,000, OOO AGGREGATE $ 4,000,000 OCCUR CLAIMSMADE $ B 04595-36-03 5/5/2007 5/5/2008 $ DEDUCTIBLE $ RETENTION $10 r 000 WC STATU- OTH- WORKERS COMPENSATION AND FP E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE 500000 $ r $ 500,000 A EMPLOYERS' LIABILITY ANY PROPRiETOP.:R"RTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? 0409-19-08 1/1/2007 1/1/2008 If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Building Department City of Fort Collins P.O. Box 580 Fort Collins, CO 80522-0580 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR AUTHORIZED REPRESENTATIVE ! ACORD 26 (2001108) Produced using Fors Boss Plus software. www.FormsBoss.com; Impressive Publishing 800-208-1977 V A%,UKU %oUMrUKA 1 lUN "1 WOO IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). IdF-101WI1TiTT7 The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. AGUKU ZO (Zuullu9) Policy Number: Date Entered: 5/4/2007 ACORD,� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YVYY) PRODUCER Ainslie Insurance Agency, Inc. 929 38th Avenue Ct. #101 Greeley, CO 80634 (970)353-8917 07-04-Q67 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED Connercial Glass, Inc. Ms Janice L. Montross 5739 Boeing Drive Loveland, CO 80538 INSURERA:Mid Century Insurance Company INSURERB:Tr ck Insurance Exchange INSURER C: INSURERD: INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR ADD' INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A COMMERCIALGENERALLIABILITY 04595-36-02 5/5/2007 5/5/2008 DAMAGE REN PREMISES Ea occuronce $ 100,000 CLAIIAS MADE 1XI OCCUR MED EXP (Any one person) $ 5,000 PERSONAL B ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 17 POLICY XMOL LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 x A ANY AUTO 04595-36-02 5/5/2007 5/5/2008 (Ea accident) $ BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ A A HIRED AUTOS NON-OWNEDAUTOS O4595-36-02 O4595-36-02 5/5/2007 5/5/2007 5/5/2006 5/5/2008 PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY: AGG EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ 4,000, OOO AGGREGATE $ 4,000,000 OCCUR CLAIMSMADE $ B 04595-36-03 5/5/2007 5/5/2008 $ DEDUCTIBLE $ RETENTION $10 r 000 WC STATU- OTH- WORKERS COMPENSATION AND FP E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE 500000 $ r $ 500,000 A EMPLOYERS' LIABILITY ANY PROPRiETOP.:R"RTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? 0409-19-08 1/1/2007 1/1/2008 If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Building Department City of Fort Collins P.O. Box 580 Fort Collins, CO 80522-0580 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR AUTHORIZED REPRESENTATIVE ! ACORD 26 (2001108) Produced using Fors Boss Plus software. www.FormsBoss.com; Impressive Publishing 800-208-1977 V A%,UKU %oUMrUKA 1 lUN "1 WOO