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HomeMy WebLinkAbout432987 MBI CONSULTING LLC - INSURANCE CERTIFICATE (4)M13ICO-1 OP ID: BA AC� R� CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) Fo6/11/12 ' 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 ): , 970-635-9400 PFS insurance Group - JTj14 — I 970-635-9401 4848 Thompson Pkwy, Ste 200 Johnstown, CO 80534 Johnstown Select Accounts - CONTACT NAME: PHONE _(AIC, No, Exn: E-MAIL -- - ADDRESS: INSURERS AFFORDING COVERAGE -- NAIC P INSURER A: EMC Insurance Companies INSURED • MBI Consulting, LLC INSURER B: Pinnacol Assurance Co 524210 PO Box 2085 Fort Collins, CO 80522 INSURER C INSURER D : INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 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. NER RINSR TYPE OF INSURANCE ADDL SOaR MD POLICY NUMDER MMIDDIYYYY MMIDDIYYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 1XI OCCUR X 3DB4658 BLANKET ADD'L INSURED 02/04/12 02/04/13 EACH OCCURRENCE $ 1,000,000 PREMISES Be occurrence) $ 50,000 MED EXP (Any one person) $ 5,000 PERSONAL B ADV INJURY $ 1,000,000 GENERAL AGGREGATE Is 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY F--] PRO- n LOC PRODUCTS - COMP/OP AGG $ 2,000,000 AUTOMOBILE LIABILITY .—,1 ANY AUTO'C al'. . ALL OWNED A SCHEDULED AUTOS` AUTOS HIREDAUTOS N-AUTOS - - _ ., y , _ EOMaEI tlDISINGLE LIMIT BODILY INJURY (Per person) $ - BODILY WJURV IP¢r. acci¢enp $ - PROPERTY DAMAGE Per accident $ 8 UMBRELLA LIAR EXCESS LIAR OCCUR I EACH OCCURRENCE $ iCLAIMS-MADE AGGREGATE $ LED I I RETENTION$ I $ B WORKERS COMPENSATION AND EMPLOYERSLIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE YIN OFFICERIMEMBER EXCLUDED' (Mandatory, in NH) If yes. describe under DESCRIPTION OF OPERATIONS below NIA - 4106693 07/01/12 07/01/13 .X WC STATU OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ 100,000 E. L. DISEASE - EA EMPLOYEE Is 100,000 E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, It more space Is required) All Locations / All Operations CERTIFICATE HOLDER CANCELLATION CITYOF3 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 PO Box 580 AUTHORIZED REPRESENTATIVE 4 Fort Collins„ CO 80522 I © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD