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HomeMy WebLinkAbout130163 EMPIRE CARPENTRY LLC - INSURANCE CERTIFICATE10/22/2010 10:39 AM FROM: TCB TO: 9702216707 PAGE: 002 OF 003 ACORDn CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDNYYY) 10/22/2010 PRODUCER (970) 484-2805 John C. Beckett &Associates, Inc. 220 Smith Street Ft. Collins CO 80524 — 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 Empire Carpentry, LLC P. O. BOX 245 Bellvue CO 80512- INSURERA:ADDISON FARMERS INS CO INSURER B INSURERC: INSURER D: INSURERE: rnVFRAQFR 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 ADO'L INSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MMIDDlYY) POLICY EXPIRATION DATE (MM/DD/YY) LIMITS A GENERAL LIABILITY 60378006 10/30/2010 10/30/2011 EACH OCCURRENCE $ 1,000,000 DAME EaMAGE( RENTED occurrence) $ 100,000 X COMMERCIAL GENERAL LIABILITY CLAIMS MADE a OCCUR _ MED I (Any one person) $ 5,000 PERSONAL &ADV INJURY $ 1,000,000 GENERAL AGGREGATE .$ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 1-1 POLICY X ACT X I EBLIA A AUTOMOBILE LIABILITY ANY AUTO 60378006 10/30/2010 10/30/2011 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ X ALL OWNED AUTOS SCHEDULED AUTOS / / BODILYIN,URY (Peraccident) S X X HIREDAUTOS NON-OVMIEDAUTO S PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC S ANY AUTO NO COVERAGE I I I I 5 AUTO ONLY: AGG EXCESS/UMBRELLA LIABILITY NO COVERAGE EACH OCCURRENCE AGGREGATE S OCCUR F1 CLAIMS MADE DEDUCTIBLE / S $ RETENTION :$ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY NO COVERAGE VVC STATU- O R TORY LIMITS ER E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. DISEASE - EA EMPLOYEES OFFICER/MEMBER EXCLUDED? If yes, describe under / / E.L. DISEASE -POLICY LIMIT $ SPECIAL PROVISIONS below OTHER NO COVERAGE DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESr=XCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS l.tK II rit-A 1 t NULL C:ANL.tLLA I IUN ( ) - (970) 221-6707 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE PURCHASING DEPT EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT CITY OF FORT COLLINS FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE PO BOX 580 INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE FORT COLLINS CO 80522- ACORD ZO (ZUU1/U8) © ACORD CORPORATION 1988 INS025 (olwym Page 1 of 2 10/22/2010 10:39 AM FROM: JCB TO: 9702216707 PAGE: 003 OF 003 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). DISCLAIMER 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. ACORD 25 (2001/08) INS025{o1o8ym AMS Page 2of2 10/22/2010 08:32:36 AM PINNACOL ASSURANCE PAGE 2 OF 3 ACORDTN CERTIFICATE OF LIABILITY INSURANCE OATS , 1MIW0/22/2010 2010 PRODUCER PINNACOL ASSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY 7501 E Lowry Blvd Denver, CO 80230-7006 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 INWRERN PINNACOL ASSURANCE 41190 EMPIRE CARPENTRY LLC 521.5 SYCAMORE ST FORT COLLINS, CO 80521 INSURERS: INSURER C: INSURER D. IN9URER 2 COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDNG ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TOALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADO'L POLICY EFFECTIVE POLICY EXPIRATION LTR IN8RO TYPE OFIN8URANCE POUCY NUMBER DATEtMMIODIYYYY) OATE(MM100fYYYY) UMIT•S GENERAL LIABILITY EACH OCCURRENCE DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR PREMISES MED EXPVry one person) PERSONAL&ADV INJURY GENERAL AGGREGATE GENLAGGREGATE LIMITAPPLIERS PER: PROOUCTS-COMNOPA00 POLICY F1 PROJECT LOG AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO cee Accldent) BODILY INJURY ALL OWNED AUTOS SCHEDULED AUTOS (Perpemon) BODILY INJURY HIRED AUT09 NON -OWNED AUTOS - (Perlccident) PROPERTY DAMAGE (P er accldent) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT OTHER THAN EA ACC ANYAUTQ .AUTO ONLY: AG E XCES 8/1.11YBRELLA LIABILITY EACH OCCURRENCE AGGREGATE OCCUR a CLAMS MADE DEDUCTIBLE RETENTION $ WORKERS CONPENSATIONANO X WCSTATU- OTHER A EMPLOYER'S LIABILITY ANY PROPRIETORlPPJZTNER/EXECUTIVE 1519600 09/01/2010 09/01/2011 TO E.L EEACH ACHACC ACCIDENT $100,000 OFFICER/MEMBER EXCLUDED! E.LDISEASE-EAEMPLOYEE $100,000 If yes, please describe under SPEOIAL PRCJISIONS below E.LOISEASE- POLICYUMIT $500,000 _ OTHER DESCRIPTION OF OPERATIONSfLOCATIONSIVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION 1263177 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE The City of Fort Collins Purchasing Division P O Box 580 Fort Collins CO 80522 THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR T MAIL 0 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO -OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Charles Doggett ACORD 25(2001/08) Underwriter ACORD CORPORATION 1988 10/22/2010 08:32:36 AM PINNACOL ASSURANCE PAGE 3 OF 3 CERTIFICATE HOLDER COPY The City of Fort Collins Purchasing Division P O Box 580 Fort Collins CO 80522 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). DISCLAIMER 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.