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Home My WebLink About432111 ALLIED INSULATION - INSURANCE CERTIFICATE/1 ® " o CERTIFICATE OF LIABILITY INSURANCE OATE(MM/DD/YYYY) I 06a8/2011 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 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 ADD Risk Services Central, Inc. Southfield MI office CONTACT NAME PHONE (866) 283-]122 FAX (947) 953-5390 (NC.Na.Esq:INC. No.: E-MAIL ADDRESS: 3000 Town Center Suite 3000 INBURER(B)AFFORDING COVERAGE NAICp Southfield MI 48075 USA INSURED INSURER A: Old Republic Ins co 24147 guilder Services Group, Inc. d/b/a Allied Insulation 6395 Brighton Boulevard INSURERS: ACE American Insurance Company 22667 INSURER C: Indemnity Insurance Co of North America 43575 Commerce City CO 80022-3110 USA INSURER D: INSURER E: INSURER F: COVERAGES CERTWICAIh NUMBIER: b1UXJ ti3B9b9 REVISION NUMBIEK: 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. Limits shown are Be requested LTR TYPE OF INSURANCE INSR MD POLICY NUMBER fuNNvyYYY,MMDD LIMITS GENERAL LIABILITY MWZY EACH OCCURRENCE $2,000,005 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $2,000, 000 CLAIMS -MADE x1 OCCUR MED EXP(Any one person) $25,000 PERSONAL &AOV INJURY $2,000,000 GENERAL AGGREGATE $5,000,000 GENT AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $10,000,000 X POLICY PRO- LOC A AUTOMOBILE LIABILITY Mwr6 18398-11 06 30 201106/30/2012 COMBINED SINGLE LIMIT 15,000,000 BODILY INJURY ( Per person) X ANYAUTO BODILY INJURY (Par acckenl) ALL OWNED SCHEDULED AUTOS AUTOS X HIRED AUTOS X NON -OWNED AUTOS MAGE UMBRELLA LIMB OCCUR ENCE WAGGRE�TE EXCESS LIAR CLAIMS -MADE DEO RETENTC B WORKERS COMPENSATION AND LIABILJTY YIN PROPRIETOR I PARTNER I EXECUTIVE OFFICERMEMBER EXCLUDED] N (Mandatory in NH) NIA WLRC46480648 Deductible - ADSANY WLRC46480636 Deductible - Minnesota 06/30/2011 06/30/2011 06/30/2012IT3 06/30/2012 OTHEMPLOYERS' IDENT S1,000,000 E.L. DISEASE -EA EMPLOYEE $1,000,000 Ues eesca sneer SO dnIPTNJN OF OPERKnONSbakow E.L. DISEASE -POLICY LIMIT S1,000,000 e Excess WC WCUC46480624 06/30/2011 06/30/2012 Retention S2,000,000 Self -Insured States Statutory included SIR applies per policy ter is & condi ions DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, AcidlBonal Remarks ScMdule, if more space's required) RE: Project Name: 215 N. Mason, Job Site: 215 N. Mason, Fort Collins, CO. City of Fort Collins is included as an Additional Insured with respect to the General Liability and Automobile Liability policies, as required by written contract. 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 AUTHORIZED REPRESENTATIVE Attn: Insurance Administrator PO BOX 580 FOrt Collinsli CO 80522 USA 01988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD 3 S