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Home My WebLink About102529 R&R BLACKS GLASS INC - INSURANCE CERTIFICATEOP ID: JA ,a�oRo CERTIFICATE OF LIABILITY INSURANCE DAT11/2100/YYYY) 11/21113 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 endorsements . PRODUCER 970-223-1804 Property 8. Casualty 1100 Haxton Dr. Suite #100 Fort Collins, CO 80625 Steven G. Smith CONTACT NAMEVolkBell PHONE FAX UVC. No ac No : E-MAIL ADDRESS:PRODUCER CUSTOMER . R&RBL-1 INSURE 9 AFFORDING COVERAGE NMC0 _ INSURED R S R Blacks Glass, Inc. A ID#344424 102SZ / 360 Jefferson Street Ft. Collins, CO 80524 INSURER A: SeCIJra insurance Companies 22543 INSURER B t Plnnacol Assurance 41190 INSURERC: 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 TR TYPE OF INSURANCE AVOL BUSH POLICY NUMBER MMIDDY EFF MMMIO I EXP LIMITS A GENERAL UABIUW X COMMERCIAL GENERALLIABILITY CLAIMS -MADE FxI OCCUR X TC003156729 12/10/13 17JI0114 EACH OCCURRENCE $ 1,000,00 PREMISES Imnc a 100,00 MED EXP one ) $ 5100 PERSONAL$ AOV INJURY S 11000,00 GENERALAGGREGATE a 2,000,00 GEML AGGREGATE LIMIT APPLIES PER: X1 POLICYF�l ]MCITPRO-LOC PRODUCTS-COMP/OP AGO S 2,000+00 EPLI 3 100,00 A A A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNEDAUTOS 3156730 A3156730 A3156730 17/10/13 12/10/13 12110/13 12110/14 12110114 12/10/14 COMBINED SINGLE LIMIT (Es accdent) $ 1,000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Par a dwt) S PROPERTY DAMAGE (Per accident) $ X X a s A X UMBRELLA LIAR CE EXBBU'a X OCCUR CWMS4AADE CU3156731 1L10M3 12/10/14 EACH OCCURRENCE $ 1,000,00 AGGREGATE $ 1,000, DDN EDUCTIBLE RETENTION 10,000 S X B WORKERSCOMPENSATION AND EMPLOYERS' LIABILITY MY N OFFICERIMEMBEREXCLUD p ECU`NVE YI❑ Illandatory In NH) Us doscribe under DESCRIPTION OF OPERATIONS below N/A 79578 07MM3 07/01M4 X WC STATU- OTH- E.L. EACH ACCIDENT $ SN+� E.L. DISEASE - EA EMPLOYEE $ 500, E.L. DISEASE - POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS / LOCATIONS/ VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if mom space Is raqulmd) Holder is listed as an additional insured with regards to the General Liability policy. CITY OF City of Fort Collins PO Box 580 Fort Collins, CO 80522 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 MM tW 1988-ZUU9 AGUKU GUKYUKA 1 IUN. All rights reserveO. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD