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HomeMy WebLinkAbout459604 SCHLOSSER SIGNS INC - INSURANCE CERTIFICATESCHLO-1 OP ID: JD '4Ei �� CERTIFICATE OF LIABILITY INSURANCE DAT08/30/13YY1 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 INSL IS), 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:970-482-7747 NAMEACT Brown & Brown Inc Fax: 970.484-4165 4532 Boardwalk Dr, Suite 200 Fort Collins, CO 80525 Sharma M Jamsay PHONE FAX ac NA Ext: ac No: EMAIL ADDRESS: INSURERS AFFORDING COVERAGE NAICp INSURER A: Firemen$ Ins Comp of WA, DC 21784 INSURED Schlosser Signs, Inc. INSURERB:Pinnacol Assurance Company 41190 Attn: Carla 3697 Draft Horse Court INSURER L: Loveland, CO 80538 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 LTR TYPE OF INSURANCE AODL MO II POLICY NUMBER MM/DD/YYYY MMIDDNYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR CPA3039997 09101113 09/01114 EACH OCCURRENCE $ 1,000,00 PREMSEs Ea occu TO RENTED $ 100,00 MED EXP(Any one person) $ 5,00 PERSONAL S ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY 1l 1 PR0 F-1 LOC PRODUCTS- COMPIOP AGG $ 2,000,00 $ A AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS CPA3039997 09/01113 09/01/14 COMBINED SINGLE LIMIT Ea accident $ 1,000,00 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ Is A X UMBRELLA LIAR I EXCESS LIAB X OCCUR CLAIMS -MADE CPA3039997 09101/13 09101114 EACH OCCURRENCE $ 5,000,00 AGGREGATE $ 5,000,00 DED X RETENTION$ 0 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE YI❑N OFFICERIMEMBER EXCLUDED? (Mandatory In NH) It yes, describe under DESCRIPTION OF OPERATIONS below NIA 4064945 09/01/113 09/01114 X WC STATU- OTH- QRYY MIT ER E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASEEAEMPLOYEE $ 1,000,00 E.L. DISEASE -POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remark* Schedule, If more space Is required) City of Fort Collins is included as additional insured per forms and conditions on page 2. CITYFC2 City of Fort Collins Attn: Purchasing & Kathleen Benedict PO Box 580 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 (2010105) The ACORD name and logo are registered marks of ACORD No Text