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HomeMy WebLinkAbout120048 BLAZER WATERPROOFING SYSTEMS INC - INSURANCE CERTIFICATE (2)AilCERTIFICATE OF LIABILITY INSURANCE A EMMI D" D06/25 IDDI13 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 1-303-534-4567 INA, Inc. - Colorado Division CONTACT NAME PHONE FAX IAIC.No Ext) INC, No: E-MAIL den aIll®1maCOr COm ADDRESS: P p 1550 17th Street Suite 600 Denver, CO 80202 INSURERS AFFORDING COVERAGE NAIC# INSURER A: COMPANION SPECIALTY INS CO (ALL RISK) 13124 ✓7 INSURED INSURER B: WESTFIELD INS CO 24112 Blazer Waterproofing Systems, Inc. INSURER C NATIONAL UNION FIRE INS CO OF 19445 INSURER D: PINNACOL ASSUR 41190 14102 East Smith Drive INSURER E: Aurora, CO 80011 INSURER F: C.OVFRAGFS C.FRTIFICATF NUMRFR- 34371608 REVISION NHMRFR- 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 ADDL SUBR POLICY NUMBER POLICY EFF MMIDDNYYY POLICY EXP MMIDDIYYYY LIMITS A GENERAL LIABILITY VGL1322252 07/01/1 07/01/14 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR PREMISES TO rr PREMISES Ea occurrence $ 50,000 MED EXP (Any one person) $ EXCLUDED PERSONAL B ACV INJURY $ 1,000,000 X PD Dad: $10,000 GENERAL AGGREGATE $ 2,000,000 GENE AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $2,000,000 POLICY X PRO- LOC - $ B LIABILITY CWP7660307 07 Ol 1 07/01/14 COMBINED SINGLE LIMIT Ea accident 1, 000, 000 BODILY INJURY(Par person)$ ANY AUTO ALL OWNED SCHEDULED$ OSBODILY AUTOS AUTHIRED POMOBILE INJURY(Per accident)NON-OWNED PROPERTY DAMAGE Per accident $ AUTOB X AUTOS C UMBRELLA LIAB X OCCUR BE018085561 07/01/1 07/01/14 EACH OCCURRENCE $ 11000,000 X AGGREGATE $ 1,000,000 EXCESS LIAB CLAIMS -MADE DED RETENTION$ $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N 404SS06 07/01/1 07/01/14 % WC STATU- DTH- ER E.L. EACH ACCIDENT $ 1, 000,000 ANY PROPRIETORIPARTNEWEXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? IN NIA E.L. DISEASE -EA EMPLOYE $ 1, 000:000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 1,000, 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) The City of Fort Collins, Colorado is included as Additional Insured on the General Liability Policy if required by written contract or agreement and with respect to work performed by Insured subject to the policy terms and conditions. 7247 Waterproofing at Civic Center Parking Structure The City of Fort Collins, Colorado' Attn: John Stephen 120 N. Mason Street Fort Collins, CO 80524 USA 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 //^ //,W ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD zrm2012 34371608 Blazer Structures POLICYNUMBER: VGL1322252 Effective: 07/01113-07/01 /14 COMMERCIAL GENERAL LIABILITY CG 20 26 07 04 THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Section 11 — Who Is An Insured is amended to In- clude as an additional Insured the person(s) ororgani- zation(s) shown in the Schedule, but only with respect to liability for "bodily Injury', "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omis- sions of those acting on your behalF. A. In the performance of your ongoing operations; or B. In connection with your premises owned by or rented to you. CG 20 26 07 04 0 ISO Properties, Inc., 2004 Page 1 of 1 '❑