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HomeMy WebLinkAboutVINCENT L KELLEY DBA AA PLUMBING SERVICES - INSURANCE CERTIFICATECERTIFICATE OF LIABILITY INSURANCE �i 26/2012 uYYYY) 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 - CONTACT Debbie Brickham NAME: First Mainstreet Insurance, LLC 275 S. Main Street, Suite 100 PHONE ,EXO: (303)776-5122 Ne): (3g3)776-$a95 E-MAIL P.O. BOX 847 -A���Ess,dbrickham@FirstMainStreet.com PRODUCER 00012174 ID. q. _CUSTOMER INSURER(S) AFFORDING COVERAGE NAICO Longmont CO HOSO2 INSURED INSURERA:Peerless Indemnity Ins Co. :18333 Vincent L. Kelley INSURER B:Plnnacol Assurance DBA: AA Plumbing Services INSURER C: P O Box 5 INSURER D INSURER E : Longmont CO 80502 INSURER F: COVERAGES CERTIFICATE NUMBER:12-13 REVISION NUMBER: 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. ILEXP TR TYPE OF INSURANCE INR NSR WBR POLICY NUMBER MMIDDYNYYY MM/DDEFF YIYYYY LIMITS GENERAL LIABILITY EACH $ 1,000,000 COMMERCIAL GENERAL LIABILITY X -OCCURRENCE DAMAGE TO RENTED—f PREMISES occurrence) $ 100, 000 A CLAIMS -MADE OCCUR CBP8597125 1/28/2012 1/28/2013 -(Ea MED EXP(My one person) Is 15,000 I$ 1,000,000 (PERSONAL B ADV INJURY GENERAL AGGREGATE Is 2, Q00, 000 GEN'L AGGREGATE LIMIT APPLIES PER: (PRODUCTS - COMPIOP AGG $ 2,000,000 X POLICY FI PRO- n LOC $ AUTOMOBILEIFCT LIABILITY, COMBINED SINGLE LIMIT (Ea accident) , 000, 000 $ 11000,000 A ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS BA8590826 1/28/2012 1/28/2013 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ X PROPERTY DAMAGE (Par accident) $ X X Uninsured motodst BI-single Is 11000, 000 NON OWNED AUTOS I Medical payments I $ 5,000 X UMBRELLA DAB X OCCUR EACH OCCURRENCE Is 1,000,000 (AGGREGATE $ 1,000,000 EXCESS LIAB CLAIMS -MADE DEDUCTIBLE $ X �— A RETENTION $. 10,000 CUS593126 1/28/2012 1/28/2013 B WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOWPARTNEWEXECUTIVE OFFICERIMEMBER EXCLUDED? (Mandatory in NH) If yeescribe s, dunder DESCRIPTION OF OPERATIONSbeI. NIA 4046912 8/1/2011 B/1/2012 I WC STATU- OTH- �TORY_LI MTSLER_1 E.L. EACH ACCIDENT $ SQQ, QQQ E.L. DISEASE - EA EMPLOYEE$ 500,000 E.L. DISEASE -POLICY LIMIT ($ SOO 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, K more space is required) City of Fort Attn: Amy P O Box 580 Fort Collins, ACORD 25 (2009/09) INS025 (200909) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Collins ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE CO 80522-0580 D Brickham/DBRICK ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD