HomeMy WebLinkAboutBROOMFIELD SHEET METAL INC - INSURANCE CERTIFICATEBROOM-1 OP ID: KR
CERTIFICATE OF LIABILITY INSURANCE
DAT12/28OYYVV)
F 12I28/11
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 endomement(s).
PRODUCER
The Wright 303.863-7788
9 P, Inc. ( PC ) 303-861-7502
Property & Casualty Division
1873 eS.r Bellaire 2 Ste. 600
Denver, CO 80222
CONTACT
NAME: Kim Rossi
PNONE 303-228-2207 FAx
-LAIC No EXt: A/C Nof:
ADDARRESS. krossi@twgservices.com
INSURERS AFFORDING COVERAGE
NAIC#
IN,uRERA..CINCINNATI INSURANCE COMPANY
INSURED Broomfield Sheet Metal, Inc.
1367 Horizon Ave.
INSURERS: PINNACOL ASSURANCE
Lafayette, CO 80026
INSURER C :
INSURER 0:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: ecvtclnM MI ln#aFa.
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.
ILTR TYPE OF INSURANCE ADDL SUB- POLICY EFF POLICY EXP
POLICY NUMBER (MM/DDNYYYI fMMIDDNYYYILIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE a OCCUR
CPP1092257
01/01/12
01/01/13
EACH OCCURRENCE
$ 1,000,000
DAMAG�T RENTED
PREMISES Ea occurrence
$ 500,000
MED EXP (Any one person)
$ 10,000
PERSONAL B ADV INJURY
$ 1,000,00
GENERAL AGGREGATE
$ 2,000,000
GENT AGGREGATE LIMIT APPLIES PER:
POLICY PRO LOC
PRODUCTS-COMPIOPAGG
$ 2,000,000
$
A
AUTOMOBILE
LIABILITY
ANYAUTO
AAUTOS OS AUTOS
S SCHEDULEDT
HIRED AUTONON-OWNED
AUTOS
CPP1092257
01101112
01101/13
COMBINEDSINGLESINGLE LIMIT
$ 1,000,000
X
BODILY INJURY (Per person)
$
BODILY INJURY Per accident
( I
$
PROPERTY DAMAGE
Per accident
$
$
A
UMBRELLA LIAB
EXCESS LIAB
X
OCCUR
CLAIMS -MADE
CPP1092257
01101/12
01101/13
EACH OCCURRENCE
$ 2,000,00
AGGREGATE
$ 2,000,000
ODID X
$
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mantlatmy in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
NIA
4038268
01/01112
01/01113
WCSTATU- OTH-
X TORV LIMITS ER
EL EACH ACCIDENT
$ 100,00
E.L. DISEASE - EA EMPLOYEE
$ 100,000
EL. DISEASE - POLICY LIMIT
$ 500,000
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (AUach ACORD 101, Additional Remarks Schedule, if more space is required)
City of Fort Collins
P.O. Box 581
Fort Collins, CO 80522
FTCOLLI
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)
u 196t5-ZU1U ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD