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HomeMy WebLinkAbout459545 HOMELAND FENCE (LESONDAK CONST) - INSURANCE CERTIFICATE"CCAR "® CERTIFICATE OF LIABILITY INSURANCE 6�ie/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 First Mainstreet Insurance, LLC 275 S. Main Street, Suite 100 P.O. BOX 847 Longmont CO 80502 CONTACT Austin Nikel NAME: ONE (3D3)776-5122 EA% No).130317T6-Sd9$ PHEVC AEpMpAgLESS.anikel@first111ainstreet.com INSURERS AFFORDING COVERAGE NAICN INSURERA.Acuity 14184 INSURED Lesondak Construction LLC, DBA: Homeland Fence 6 Security 6204 Jack Pine Drive Bellvue CO 80512 INSURER B : INSURERC: INSURER D: INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER:Master 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. IN$R TR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER FMLICY EFF PMUCY EXP LIMITS GENERALLIABIUTY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE aOCCUR L87231 6/24/2012 6/24/2013 DAMAGE TO REMEI PREMI nnce $ 100,000 MED EXP (Any oneperson) $ 5,000 PERSONAL B ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 X POLICY PRO- LOC JFCT $ AUTOMOBILE UABIUTY COMBINED SINGLE LIMITLa 1,000,000 BODILY INJURY (Par person) $ A ANY AUTO ALL OWNED SCHEDULED AUTOS X AUTOS 87231 6/24/2012 6/24/2013 BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per n $ NON -OWNED HIREDAUTOS AUTOS X Medical payments $ 5,000 19 UMBRELLA UAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS UAB CLAIMS -MADE DED I I RETENTIONS $ WORKERS COMPENSATION WC STATU- OTH- T. AND EMPLOYERS' UABIUTV YINLIM ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? NIA E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) Use, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE- POLICY LIMIT $ DESCRIPTION OF OPERATONS / LOCATIONS/ VEHICLES (Attach ACORD 101, Additional Remarks Schedule, i( more space is required) City of Fort Collins is named as additional insured in regards to General Liability only with City issued Permit. (CB-7028) (970) 221-6707 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS. Purchasing John Stevens AUTHORIZED REPRESENTATIVE PO Box 580 Fort Collins, CO 80522-0580 ,�,r�J Austin Nikel/AUSTIN a w,�- /4✓ ACORD 25 (2010/05) INS025 (201005).01 ©1988.2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD