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HomeMy WebLinkAbout130563 HOME BUILDERS SERVICES INC - INSURANCE CERTIFICATE (2)SAFET-9 OP ID: DP
A�ORO CERTIFICATE OF LIABILITY INSURANCE D12123/2013Y)
12l23l20t 3
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
PRODUCER Phone: 970-356-8030
NXM"I
Rich & Cartmill Ins of CO Fax: 970-356-8032
of
_
PHONE , Eap: _ FAX_
Nol: -------- -- --
8213 W. 20th Street
Greeley, CO 80634
Michael J Schmitt CIO
EI_ D :
-
_ _ --T__INSURER(S) AFFORDING COVERAGE _ NAIC0
._
INSURERA Twin City Fire Insurance Co
INSURED Safety Rall Of Colorado Inc;
�1 1- Custom Fence & Supply Inc;-
\y.e 6 %_*Home Builders Services Inc;
INSURER B: DepOSItOB IrISUfanCe
INSURER C _Pinnacol Assurance
INSURER D:
Custom Leasing Inc
3031 Highway 119
Longmont, CO 80504
INSURER E:
- -- — -
NSURERF:
COVFRAf FS C.FRTIFICCTF NIIMRFR- RFVISION 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.
Amilluff
INSR LR TYPE OF INSURANCE POLICY NUMBER , MMIUD/YYYY M DDIYYXYY LIMITS
T
GENERAL LIABILITY
EACH OCCURRENCE
S 1,000,00
A
XCOMMERCIAL GENERAL LIABILITY
X
34 ECS OA8354 01101/2014
01101/2015
PREMISES DAMAGE TO RENTED
MIES Elu
i 300,00
____
I
CLAIMS-MADE [X OCCUR
NEED EXP (Any one ii r )
S 10,000.
�� PERSONAL S ADV INJURY
3 1,000,00
.
X Contractual Limb
GENERAL AGGREGATE
S 2,000,00
GENT AGGREGATE LIMIT APPLIES PER'.
PRODUCTS - COMPIOP AGG
S 2 000,00
X POLICY JFDTPRO- LOC
Emp Ben.
_ _
$ 1,000,00
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
eacmdom) -
1,000,00
____ _
tS
B
X ANY AUTO
7534734203
01101/2014
01101/2015
BODILY INJURY (PW WM)
ALL OWNED SCHEDULED
AUTOS AUTOS
BODILY INJURY(PW amitlel0
S
PROPERTY DAMAGES
Peraccl enl
NON -OWNED
HIRED AUTOS AUTOS
S
UMBRELLA llAS
OCCUR
EACH OCCURRENCE
S
AGGREGATE
S
EXCESS UPS
CLAIMS -MADE
DEO I I RETENTIONS
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
C ANY PROPRIETORIPARTNER/EXECUTIVE YIN
724
01101/2014
01/01/2015
X WC STATU- DER.
-
E.LEACH ACCIDENT
$ 600,000
OFFICERIMEMBER EXCLUDED? ❑
(Mandatory in NH)
NIA
---
E.L. DISEASE -FA EMPLOYEES
-'-- ----'
500,
If Yes. tlescribe antler
DESCRIPTION OF OPERATIONS Below
E L. DISEASE -POLICY LIMIT
S 500100
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (AKaeN ACORD 101, Addltl anal Remarks Schedule, It more space is requlr,d)
City of Fort Collins is named as additional insured as pertains to the
general liability policy, per written contract.
CITFCO
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Fort Collins THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
tY ACCORDANCE WITH THE POLICY PROVISIONS.
215 N Mason St
Fort Collins, CO 80522 AUTHORIZED REPRESENTATIVE
Michael J Schmitt CIC
U 19UU-2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (201W05) The ACORD name and logo are registered marks of ACORD