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Home My WebLink AboutMIELKE CONSTRUCTION INC - INSURANCE CERTIFICATEMIELK-1 OF ID: BA Af— "',c"_ CERTIFICATE OF LIABILITY INSURANCE DAT06/23DIYYYYI F 06/23/11 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 endorsements . PRODUCER 970-635-9400 PFS Insurance Group -JT g70-635-9401 4648 Thompson Pkwy, Ste 200 Johnstown, CO 80534 TLC -Special Accounts CONTACT PHONE FAX AIL No Eat: A/L No: E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC p INSURER A: PInnacol Assurance Co 41190 INSURED Mielke Construction, Inc. Sara Mielke INSURER B: PO BOX 7155 INSURER C: INSURER D Loveland, CO 80537 INSURER E INSURER F COVERAGES CFRTIFICATF NIIMRFR ovsmm�u wlas000. 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, INSR LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIDDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY CLAIMS -MADE D OCCUR ETA—MAGE TC RENTEDPREMISES Ea occurrence IS MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GENT AGGREGATE LIMIT APPLIES PER. PRODUCTS COMPIOP AGG $ POLICY PRDJEC LOC § AUTOMOBILE LIABILITY Ea COMBINED ISINGLE LIMIT $ BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) § HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE Per accident $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS -MADE DEO RETENTION$ $ A WORKERS COMPENSATION ANDEMPLOYERS'LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE YIN OFFICERIMEMBER EXCLUDED? ❑ NIA 4144560 07101/11 07101/12 WC STATU- OTH- X Y IMIT R E.L. EACH ACCIDENT $ 100,000 E. L. DISEASE - EA EMPLOYEE $ 100,000 (Mandatory In NHl It yes, descrbe under E. L. DISEASE -POLICY LIMIT 1 It 500,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) Construction/All Locations /All Operations City of Fort Collins P.O. Box 580 Fort Collins„ CO 80522 CTYFTCO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2010/05) v TBbb-Zulu ACORU CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD