HomeMy WebLinkAboutCLARK STREET DESIGN BUILDERS INC - INSURANCE CERTIFICATECERTIFICATE OF LIABILITY INSURANCE
ACORD.
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GATE MMD
oa/24/2014
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
Ewing -Leavitt Insurance Agency
4025 St. Cloud Dr.
Suite 100
Loveland, CO $0538
CONTACT
NAME: Dustin Sadowski
PHONE No, Ea:970.679.7375 ac,Na;866.456.4265
ADDRESS: dustin-sadowski@leavitt.com
INSURER(S) AFFORDING COVERAGE
NAICN
INSURER A: Addison Insurance Company
10324
INSURED Clark Street Design Builders, Inc
1200 Clark St
Fort Collins, CO 80524
INSURER B:
INSURER C:
INSURER D:
INSURER E :
INSURER F:
COVERAGES CERTIFICATE NUMBER: 14-15 Master REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR
TYPE OF INSURANCE
INSR
WI
POLICY NUMBER
INMIDD;VYYY)
MM/DD/YYYY
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE O OCCUR
603573$
04/22/2014
0412212015
EACH OCCURRENCE
$ 1,000,00
PREMISES Ea occurrence
$ 100,00
MED EXP (Any one person)
$ 5 , 0O
PERSONAL &ADV INJURY
$ 1,000,00
GENERALAGGREGATE
$ 2,000,00
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY ECTPRO-
X J ECT LOC
PRODUCTS-COMP/OP AGG
$ 2,000,00
$
AUTOMOBILE
LIABILITY
ANY AUTO
ALLOWNED SCHEDULED
AUTOS AUTOS
NON OWNED
HIREDAUTOS AUTOS
Ea accident)
$
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
Per accident
$
UMBRELLA LIAB
EXCESS LIAB
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
$
AGGREGATE
$
DED I I RETENTION$
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETOR/PARTNER/EXECUTIVFj—I
OFFICERIMEMBER EXCLUDED? u
(Myandatory In NH)
describe under
DESCRIPTION OF OPERATIONS below
N/A
IAIU-
TORY LIMITS I I ER
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYEE
$
E.L. DISEASE -POLICY LIMIT
$
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more apace Is required)
FAX:1r970t224.6134
City of Fort Collins
281 N. College Ave.
Fort Collins, CO 80524
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 cl f, i.,
All rahts
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD