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HomeMy WebLinkAbout432987 MBI CONSULTING LLC - INSURANCE CERTIFICATE (6)MBICO-1 OP ID: BA A�ORO CERTIFICATE OF LIABILITY INSURANCE D01 /1512014Y) 01 /15/2014 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 PFS Insurance Group - JT 4848 Thompson Pkwy, Ste 200 Johnstown, CO 80534 Johnstown Select Accounts CONTACT PHONE FAX A/c No Alc No): EMAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIL fl INSURER A:EMC Insurance Companies 21415 _ LLC (J INSURED IM IBox INSURER B: Pinnacol Assurance Co 41190 2085ng, 432 Fort Collins, CO 80522 11 INSURER C: INSURER D : INSURER E : INSURER F : COVFRAGFS CFRTIFICATF Nt1MRFR: RFVIS1nN NIIMRFR- 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 I rypE OF INSURANCE ADDL B POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FX-1 OCCUR X 31D84658 BLANKET ADD'L INSURED 02/04/2014 02/04/2015 EACH OCCURRENCE $ 1,000,00 PREMISES Ea occurrence $ 50,00 MED EXP (Any one person) $ 5,00 PERSONAL BADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY 7 PROEC� LOC PRODUCTS - COMP/OP AGG $ 2,000,00 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE PER ACCIDENT $ UMBRELLA UAS EXCESS IJAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION$ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? El (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA 106693 07/01/2013 07/01/2014 X WC STATU- OTH- R E.L. EACH ACCIDENT $ 100,00 E.L. DISEASE - EA EMPLOYEE $ 100,00 E.L. DISEASE -POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if mom space Is required) All Locations / All Operations CFRTIFICATF HAI nFR CANCFI I ATInN CITYOF3 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 PO Box 580 AUTHORIZED REPRESENTATIVE 4 Fort Collins„ CO 80522 © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD