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HomeMy WebLinkAbout432987 MBI CONSULTING LLC - INSURANCE CERTIFICATE (5)MBIC0.1 OF ID: BA ,d►�,�zo CERTIFICATE OF LIABILITY INSURANCE D01/18/2013ATE r) ' 01/18/2013 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_ IN_SURER(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 Phone: 970-635-9400 ACT -- NAME FES Insurance Group - JT' 635 4848 Thompson Pkwy,, Ste 200 Fax: 970--9401 Johnstown, CO 80534 Johnstown Select Accounts PHONE FAX - ac No Est: - -- -- (aIC,_No): ' E-DRESS:MAIL AD INSURER(5)AFFORDING COVERAGE --"— NAICp INSURER A:EMCInsurance Companies - 21415 INSURED MBI Consulting, LLC - PO Box 2085 Fort Collins, CO 80522 INSURER B: Pinnacol Assurance Co - - 141190 '- 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. INSR R TYPE OFINBURANCE ADDL SUER NUMBER POLICYPOLICY MMIDDYYYY MM`DDEFF Y EXP YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 A X COMMERCIAL GENERAL LIABILITY X 3D84658 02/04/2013 02/04/2014 DAMA T R NT D PREMISES Ea occurrence $ 50,000 CLAIMSMADEOCCUR MED EXP(Any one person) $ 5,000 PERSONAL S ADV INJURY $ 1,000,000 BLANKET ADDL INSURED GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPIOPAGG $ 2,000,000 POLICY F7 PRO- n LOG $ " AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Eaaccident) - $ BODILY INJURY (Per person) ANY AUTO .. ALL OWNED SCHEDULED AUTOS AUTOS ' BODILY INJURY (Per accident) $ -- PROPERTY DAMAGE Peraccicant $ NON -OWNED HIRED AUTOS AUTOS .. - - $ (UMBRELLA LIAB OCCUR - - EACH OCCURRENCE $ _ AGGREGATE $ " EXCESS LIAB CLAIMS -MADE _ _ .,-. _,. _ DED RETENTIONS $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE YIN OFFICERIMEMBER EXCLUDED? (Mandatory in NH) N I A 4106693 07/01/2012 07/01/2013 .. WC STATU- OTH- X TORY LIMITS ER E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE -EA EMPLOYEE '$ 100,000 If yes, describe under DESCRIPTION OF OPERATIONS below " - E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if 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 Fort Collins„ CO 80522 ACORD 25 (2010105) © 1988.2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD