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HomeMy WebLinkAboutFARQUHAR MASONRY - INSURANCE CERTIFICATEFAKUU-1 UP IU: bA ,41 CERTIFICATE OF LIABILITY INSURANCE �/ ATE (MM1TOrYYYY) 03/11/2013 03/11/2013 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 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 . PRODUCER Phone: 970-635-9400 CONTACT PFS Insurance Group -JT Fax: 970-635-9401 4848 Thompson Pkwy, Ste 200 Johnstown, CO 80534 Johnstown Select Accounts PHONE FAX A/C. No Eat), (AID, No): EMAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAICp INSURER A: PInnacol Assurance CO 41190 INSURED Farquhar Masonry INSURERB-Hartford Insurance Co. 129424 Peter Farquhar 900 W. Prospect Rd. INSURER C:American States Ins. Company 19704 Ft. Collins, CO 80526 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. SUSR ILTR NSR TYPE OF INSURANCE INSR ADDLTI MOII POLICY NUMBER MMIDDYOL'C)I MMIDD� LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 B X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 191 OCCUR 34SBAPJ8108 06/06/2012 06/06/2013 DAMAGE TO RENTED PREMISES IEa occurrence) $ 100,000 MED EXP (Any one person) $ 10,00 PERSONAL B ADV INJURY S 1,000,00 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY FI PRO n LOC I $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 1,000,00 BODILY INJURY (Per person) $ C ANY AUTO 24CC2919232 05/02/2012 05/02/2013 ALL AUTOSMED �AUTOSULED 1H-� BODILY INJURY (Per accitlenp $ PROPERTY DAMAGE {Peraccident) $ NON -OWNED HIRED AUTOS AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE l AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERIEXECUTIVE Y/N OFFICERPAEMBER EXCLUDED9 (Mandatory in NH) NIA 4079677 04I01I2013 04I01I2014 X WC STATU- OTH- TORV LI-MITS ER_ E.L. EACH ACCIDENT $ 500,00 E.L. DISEASE - EA EMPLOYEE $ 500,00 Dyes describe under DESCRIPTION OF OPERATIONS below E. L. DISEASE - POLICY LIMIT $ 500,000 B Installation - 34SBAPJBIOB 06/06/2012 06/06/2013 Install. 20,000 Floater Floater DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Project: Parking Permit If required by written contract or written agreement, the certificate holder is included as additional insured for ongoing operations under general liability. CTYFTCI City of Fort Collins Front Desk 215 N. Mason Street 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 © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD