HomeMy WebLinkAbout130563 HOME BUILDERS SERVICES INC - INSURANCE CERTIFICATESAFET-9 OP ID: DP
CERTIFICATE OF LIABILITY INSURANCE
DAT12/21/12 V)
2/21
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 endorsements .CNTACT
PRODUCER _ _.. .. 970-356.8030
NAME:
Rich & Cartmill Ins of CO - 970-356-8032
ofColoradoLLC
Street
Greeley, CO 80634
Michael J Schmitt CIC
_PAHIONE x: - - - FAX
AIC No
E-MAIL8213W..20th - - - - -
DDRESS:
x
INSURERS AFFORDING COVERAGE
NAICN
INSURER A: Depositors Insurance
INSURED Safety Rails of Colorado Inc;
Custom Fence & Supply Inc;
-�j Home Builders Services Inc; i; O
INSURER B: Pinnacol Assurance
INSURER C:Twin City Fire Insurance Co
Custom Leasing Inc.
INSURER D:
INSURER E:
3031 Highway 119
Longmont, CO 80504
INSURER F
rnaeencec CERTlFlceTF NUMBER! REVISION NUMBER:
V THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELO'.'V 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
MM DD/YYYY
EXP
MMIDDfYYY Y
LIMITS
C
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE J OCCUR
X
34CESOA8364
-
01/01/13
-.
01/01114
_ ..
EACH OCCURRENCE
$ 1,000,00
To RENTED
PREMISES Eaoccunence
$ 300,00
MED EXP (Any one person)
$ 10,00
PERSONAL S ADV INJURY
$ 1,000,00
GENERAL AGGREGATE
$ 2,000,00
GEN'L AGGREGATE LIMIT APPLIES PER:
X 'POLICY PRO LOG
PRODUCTS - COMPIOP AGG
$ 2,000,00
Emp Ben. - `
$ 1,000,00
A
AUTOMOBILE LIABILITY— -
X ANY AUTO
ALL OWNED SCHEDULED
AUTOS _ AUTOS
NON -OWNED
HIREDAUTOS AUTOS
_
7504734203
- -
01/01113
01101/14
Ea acccidentSINGLE LIMIT
$ 11000,00
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
Peraccident
$
$
UMBRELLA LIAR
EXCESS LIAB
CLAIMSMADEI
EACH OCCURRENCE
$
HOCCUR
AGGREGATE
$
DED I I RETENTIONS
$
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETORFARTNERIEXECUTIVE ---1 YIN
OFFICERIMEMBER EXCLUDED?
(Mandatory In NH)
If s, dosaiba under
DESCRIPTION OF OPERATIONS below
NIA
4098724
01I01113
01I01114
X I VYCSTATU- I OTH-
ER
E.L. EACH ACCIDENT
$ 500,00
E.L. DISEASE - EA EMPLOYE
$ 500,00
EL.DISEASE - POLICY LIMIT
$ 600,000
OESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
City of Fort Collins is named as additional insured as pertains to the
general liability policy.
CITFCO
City of Fort Collins
215 N Mason St
Fort Collins, CO 80522
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
Michael J Schmitt CIC
n 1CIRR.911110 ACORD CORPORATION. All rights reserved
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD