Loading...
HomeMy WebLinkAbout130163 EMPIRE CARPENTRY LLC - INSURANCE CERTIFICATE (5)10/1/2013 11:43 AM FROM: Beckett and Associat John C Beckett and Associates TO: 2216775 PAGE: 001 OF 001 ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE (MMDDI13 10/Ol/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 endorsement(s). PRODUCER CONTACT NONE: LINDA DECKER JOHN C. BECKETT & ASSOCIATES, INC. PHONE o, EMI: (970) 484-2805 (FAA/0 N0): (990) 989-2885 nooaess: linda@beckettinsurance.com 220 Smith Street PRODUCER EMPIRE CARPENTRY LLC CUSTOMER ID p. INSURER(S) AFFORDING COVERAGE NAIC# Ft. Collins CO 80524— INSURED INSURER A ADDISON FARMERS INS CO 10324 EMPIRE CARPENTRY LLC INSURER B PO BOX 245 INSURER C INSURER D INSURER E BELLVUE CO 80512-0245 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. INSB LTR TYPE OF INSURANCE POOL INSB SUBB WVD POLICY NUMBER POLICY EFF (MNDD/YTTT) POLICY E%P (MNDD/YTTT) LIMBS A GENERAL LIABILITY 50378006 0/30/2013 0/30/2014 EACH OCCURRENCE $ 1000000 X COMMERCIAL GENERAL LIABILITY / / / / DAMAGE TO RENTED PREMISES Ea occurrence $ 100000 CLAIMS -MADE 1XI OCCUR / / / / MED FAR (Any one person) $ 5000 PERSONAL & ADS INJURY $ 1000000 GENERAL AGGREGATE $ 2000000 GEN'L AGGREGATE LIMIT APPLIES PER'. / / / / PRODUCTS - COMP/OPAGO $ 2000000 X POLICY PRO LOC JECT / / / / ALICE $ A AUTOMOBILE LIABILITY ALLOMENY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS 0378006 0/30/2013 / / / / / / 0/30/2014 / / / / COMBINED SINGLE LIMIT (Ea accident) $ 1000000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ X PROPERTY DAMAGE (Peraccident) $ X NOWOWNED AUTOS / / / / X $ UMBRELLA LIPS OCCUR 0 COVERAGE / / / / EACH OCCURRENCE $ EXCESS LIPB CLAIMS -MADE / / / / AGGREGATE $ / / / / DEDUCTIBLE $ RETENTION $ / / / / $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOPPARTNER/EXECUTIVE 0 COVERAGE / / / / WC STATU- OTH- TOALLMTS ER EL EACH ACCIDENT $ OFFICEWMEMBER EXCLUDED' F (Maddai in NH) N/A / / / / E. L. DISEASE - EA EMPLOYEE $ If yes describe under DESCRIPTION OF OPERATIONS below / / / / ELDISEASE- POLICY LIMIT $ 0 COVERAGE DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, R more space Is required!) CERTIFICATE HOLDER CANCELLATION ( ) - (970) 221-6775 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 PURCHASING DEPT . AUTHORIZED REPRESENTATIVE PO BOX 580 FORT COLLINS CO 80522-0580 1, .§ .t *'.. ''�'' t ACORD 25 (2009/09) © 1988-2009 ACORD CORPORATION. All rights reserved. INS025 (200909) The ACORD name and logo are registered marks of ACORD