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HomeMy WebLinkAboutRIDGELINE CONSTRUCTION INC DBA PERFORMANCE RECREAT - INSURANCE CERTIFICATECity of Ft. Collins INTERFAX 1 s.. R CERTIFICATE OF LIABILITY INSURANCE �' DATE (MM/DDN2013) 11/19/2013 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 CENTENNIAL INSURANCE AGENCY, LLC. 1515 Fortino Blvd. Ind Floor Pueblo CO 81009 CONTACT Robin En Tam NAME: g A/CNNo Ext: (719)544-1111 FAX No: (719)595-5120 ADDRESS.rengram@centennial-ins.com INSURERS AFFORDING COVERAGE NAIC # INSURER A Addison Insurance Company 10324 INSURED RIDGELINE CONSTRUCTION, INC. DBA PERFORMANCE RECREATION P.O. BOX 8603 PUEBLO CO 81009 INSURERB'Pinnacol Assurance 41190 INSURER C: I INSURER D INSURERS: INSURERF: COVERAGES CERTIFICATE NUMBERREVISED 13/14 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 MAYHAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDLSui INSR WVD POLICY NUMBER POLICY EFF MMIDDNVVV POLICY EXP MMIDDNVVY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 PREMISES Ea occurrence $ 100,000 X COMMERCIAL GENERAL LIABILITY A CLAIMS -MADE Filoccup 60438402 0/7/2013 0/7/2014 MED FAR (Any one person) $ 5,000 PERSONAL& ADS INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OPAGA $ 2,000,000 X POLICY PRO-LOC $ LIABILITY INED Ee aoddentSINGLE LIMIT 500,000 BODILY INJURY (Per person) $W P'ALL ANY AUTO ONED SCHEDULED AUTOS X AUTOS 60438402 0/7/2013 0/7/2019 POMOBILE BODILY INJURY (Per accident) $ PROPERTY DAMAGE Peracadent $ X NON-OMED HIRED AUTOS AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ ISGREGITE $ EXCESS LIAR GLAIIvIB-IIvIADE DED I I RETENTION $ B WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y/N PROPRIETOR/PARTNEAEXECUTIVE X WCSTATU- OTH- CRYANY E.L. EACH ACCIDENT $ 100,000 OFFICEAMEMBER EXCLUDED? (Mantlato, In NH) N/A 4133783 /1/2013 /1/2014 EL. LIISEo.SE- Eo.EMPLOYE $ 300000 If yes describe under DESCRIPTION OF OPERATIONS below EL.DISEASE -POLICY LIMIT $ SOO OOO DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Certificate holder is named as additional insured in regards to general liability per policy forms and conditions. CERTIFICATE HOLDER CANCELLATION (970) 221-6707 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Ft. Collins ACCORDANCE WITH THE POLICY PROVISIONS. Purchasing Department AUTHORIZED REPRESENTATIVE P.O. BOX 280 Ft. Collins, CO 80522 Patricia Files/PAT 1. i-i ACORD 25 (2010105) NS025 /901 oos o1 ©1988-2010 ACORD CORPORATION. All rights reserved. Tha ar-ni names anrt Innn aria ronic}arort marks of arni