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HomeMy WebLinkAbout102529 R & R BLACKS GLASS INC - INSURANCE CERTIFICATEOP ID: JA CERTIFICATE OF LIABILITY INSURANCE DAT11127112YY) 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 terns 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 endorsements . PRODUCER 970-223-1804 CONTACT VolkBell Property & Casualty 1100 Haxton Dr. Suite #100INC.No Fort Collins, CO 80526 Steven G. Smith {� PHONE FAX EXI : ac No): E-MAIL ADDRESS: PRODUCER CUSTOMER ID p:R&RBL-1 INSURERS AFFORDING COVERAGE NAIC p v V INSURED R & R Blacks Glass, Inc. INSURERA: Secura Insurance Companies 22543 I13#344424 INSURER B: Pinnacol Assurance 41190 360 Jefferson Street Ft. Collins, CO 80524 INSURERC: 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. INSR LTR TYPE OF INSURANCE POLICY NUMBER INNNY) MMIDDY IMMIDDIYYYYI LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Fx_] OCCUR X TC003156729 12/10/12 12/10/13 EACH OCCURRENCE $ 1,000,00 PREMISES Ea«wnence $ 100,00 MED EXP (Anyone person) $ 5,00 PERSONAL B ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,000 GEN-L AGGREGATE k POLICY LIMIT APPLIES PER: PRO LOG PRODUCTS - COMPIOP AGG $ 2,000,00 EPLI $ 100,00 A A A AUTOMOBILE LIABILITY ANYAUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS A3156730 A3156730 A3156730 1211 O112 12/10/12 12/10/12 12/10/13 12/10/13 12/10/13 COMBINED SINGLE LIMIT (Ea awident) $ 1,000,00 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ X X $ $ A X UMBRELLA LAB EXCESS LIAB X OCCUR CLAIMS -MADE CU3156731 12I70/12 1211 ON 3 EACH OCCURRENCE $ 1,000,00 AGGREGATE $ 1,000,0D DEDUCTIBLE RETENTION $ 10,000 $ X It B WORKERS COMPENSATION IA AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE YIN OFFICERIMEMBER EXCLUDED? (Mandatory In NH) If yes, descnbe under DESCRIPTION OF OPERATIONS below N I A 4079578 07/01/12 07/01/13 X I WC STATU- OTH - E.L. EACH ACCIDENT $ 500,00 E.L. DISEASE - EA EMPLOYEE $ 500,00 -POLICY LIMIT $ 500,00 7SE DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule. It mom apace Is required) Holder is listed as an additional insured with regards to the General Liability policy. CERTIFICATE HOLDER CANCELLATION CITY OF SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CI Of FOR CollinsTHE City EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Fort Collins Utilities PO BOX 580 AUTHORIZED REPRESENTATIVE � p Fort Collins, CO 80522 © 1988.2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD