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HomeMy WebLinkAbout486984 REYNOLDS INLINER LLC - INSURANCE CERTIFICATEncoRO CERTIFICATE OF LIABILITY INSURANCE s/v2o13 OA/9/2DDlYYYY) 4/9/2012 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(les) 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 Lockton CCONTACT ogPanies, LLCA Kansas City 444 W. 47th Street, Suite 900 - Kansas Cityy 64112-1906 (816)960-9000 - PH o Ext : A FAX NCNEN.'No E-MAIL INSURER A: Old Republic Insurance Company 24147 INSURED REYNOLDS INLINER, LLC 1054252 1775 EAST 69TH AVENUE DENVER CO 80229 INSURER B : American Guarantee and Lialf. Ins. CO. 26247 INSURER C: INSURER 1) COVERAGES 1,AYINOI FK CERTIFICATE NUMBER: 10726004 REVISION NUMBER- XXXXXXX 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 Im TYPE OF INSURANCE ADDL R SUBR POLICY NUMBER PMLICDEFF POLICY EXP LIMITS A GENERAL LIABILITY X COMMERCIALGENERALLIABILITY CLAIMS -MADE M OCCUR X CONTRACTUAL Y N MWZY 59644 5/1/2012 5/1/2013 EACH OCCURRENCE 2,000,000 PREMI ETOEaE¢orran 500000 MED EXP (Any one erson 10,000 PERSONAL&ADV INJURY s 2,000,000 GENERAL AGGREGATE s 51000,000 GEN'L AGGREGATE LIMIT APPLIES PER. 7 P V PRO-JECT F-1 C PRODUCTS - COMP/OP AGO s 5,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO AUTOS NED SCHEDULED HIRED AUTOS X AUUTOS N N M WTB 21603 5/l/2012 5/l/2013 EeCOMBINED SINGLE LIMIT $ 5,000 000 X BODILY INJURY (Per permn) $ XXXXXXX BODILY INJURY (Per acodcrt $ XXXXXXX X P.r.cclde DAMAGE $XXXXXXX• $XXXXXXX B X UMBRELLA LIAB EXCESS LULB X OCCUR CLAIMS -MADE N N 3807886-08 5/12012 5/1/2013 EACH OCCURRENCE $ 1000000 AGGREGATE s 1,000,000 DED I X I RETENTION $ 10,000 $ XXXXXXX A A WORKERS COMPENSATION AND EMPLOYERS'LUIBILITY YIN ANY PROPRIETOHIPARTNER EOU➢W ❑ OFFIOEP/MEMDER EXCLUDED? N irinninton in NH) If DESCRIPTION OF OPERATIONS... NIA N MWC 11748000 STOPGAP ND,OH,WA,WY\ 1 5/I/2012 5/I/20I2 5/12013 5/1/2013 X WC STATU- OTH- TRY LIMITFIR S R E.L. EACH ACCIDENT s 5,000,000 E.L. DISEASE - EA EMPLOYEE 5000000 E 1. nI5E45F-POLICY LIMIT 1A 5000000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES /(Attach ACORD 101, Additional Remarks Schedule, if more space is required) CITY OF FORT COLLINS, COI-ORADO IS AN ADDITIONAL INSURED AS RESPECTS GENERAL LIABILITY COVERAGE, ONLY AS REQUIRED BY CONTRACT, SUBJECT TO THE TERMS AND CONDITIONS OF THE POLICY. a IZM I IrIUA I C MULUCN UAINI t:LLA 1 IUN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELNERED IN ACCORDANCE WITH THE POLICY PROVISIONS, 10726004 AUTHORIZED REPRESENTATIVE CITY OF FORT COLLINS, COLORADO 4316 LAPORTE AVE. FORT COLLINS CO 80522 1 1 &wv)A4`1Lv ACORD 25 (2010/05) ©9 8-2010 AC ORPORATION. All rights reserved the ACORD name and logo are registered marks of ACORD %.. R CERTIFICATE OF LIABILITY INSURANCE L� s/uzo13 TE DA4/9/2012 Y) 4/9/2012 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 LOCkton Companies, LLC-1 Kansas City 444 W. 47th Street, Suite 900 Kansas City 64112-1906 (816)960-9000 CONTACT N No Est): FAX INC, No E-MAIL INSURER A: Old RC ublic Insurance Compariv 24147 INSURED REYNOLDS INLINER, LLC 26 7915 CHERRYWOOD LOOP KIOWA, CO 80117 INSURER B: INSURER C: INSURER F COVERAGES LAYIN01 FK CERTIFICATE NUMBER: 11412295 REVISION NUMBER- XXXXXXX ------------------ THIS IS 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 Im TYPE OF INSURANCE ADDL N SUBR POLICY NUMBER POLICY EFF POEXP LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 7 OCCUR X CONTRACTUAL Y N MWZY59644 5/12012 5/1/2013 EACH OCCURRENCE 2,000000 DAMAGE TORENTED.T) $ 500000 MED EXP (Ary onePerson) 10,000 PERSONAL 4 ADV INJURY $ 2,000,000 GENERAL AGGREGATE s 5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X Y PRO- 0 JFCT LOC PRODUCTS - COMP/OP AGG s 5,000,000 A AUTOMOBILE LIABILITY ANY AUTO AUTOS NED SAUTHEDULED HIREDAUTOS X AUTOOWNED 33 N N MWTB 21603 1 5/12012 5/1/2013 COMBINED SINGLE LIMIT a is.N.F0 s 5,000,000 X BOD ILY INJURY (Per person) $ XXXXXXX BODILY INJURY (Per accident $ XXXXXXX X PPROPPEoreRa DAMAGE g XXXXXXX $XXXXXXX UMBRELLA LIAR EXCESS LIAR OCCUR CLAIMS -MADE NOTAPPLICABLE EACH OCCURRENCE $ XXXXXXX AGGREGATE $ XXXXXXX DED I I RETENTION $ $ A A ANDEMPLO ERS'LABILIRS OTY Y/N OFFICERIMEMBEREEXCLUDED?ECUTIVE Z IMyandetory in NH) DESCRIPTION OF OPERATIONS... NIA N MWC 11748000 STOPGAP(ND,OH,WA,WY) 5/1/2012 5/1/2013 X WCSTATU- OTH- T RYCIDENT E.L. EACH ACCIDENT $ 5,000,000 E.L. DISEASE - EA EMPLOYEE 5000000 E.L. DISEASE -POLICY LIMIT 5.000 OI/0 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES I(Anach ACORD 101, Additional Remarks Schedule, if more space is required) RE: FT. COLLINS, CO. 7106 CIP SANITARY SEWER STORMWATER MAINS REHAB. CERTIFICATE HOLDER IS AN ADDITIONAL INSURED AS RESPECTS GENERAL LIABILITY COVERAGE, ONLY AS REQUIRED BY CONTRACT, SUBJECT TO THE TERMS AND CONDITIONS OF THE POLICY. a am irii-mla nui-uan GANI LLLAI IVN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 11412295 AUTHORIZED REPRESENTATIVE CITY OF FT. COLLINS PURCHASING DIVISION PO BOX 580 FT. COLLINS, CO 80522 ACORD 25 (2010/05) © 9 8-2010 ACCVrDPORPOPATION. All rights reserved The ACORD name and logo are registered marks of ACORD