HomeMy WebLinkAboutFOOTHILLS GUTTER & INSULATION DBA TELK SHEET METAL - INSURANCE CERTIFICATEOP ID: VIM
A`o�Ro' CERTIFICATE OF LIABILITY INSURANCE
D0511ATE 21201YYI
OS/12/2014
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 endorsements .
PRODUCER
PFS Insurance Group -JT
4848 Thompson Pkwy, Ste 200(A/C,
Johnstown, CO 80534
Dave Janssen
CONTACT
PHONE FAX
No Eat): AIC No
E-MAIL
ADDRESS:
PRODUCER FOOTH-5
CUSTOMER ID p:
INSURERS) AFFORDING COVERAGE
NAIC d
INSURED Foothills Gutter & Insulation
INSURER A: EMC Insurance Companies
21415
Inc.
INSURER B: Plnnacol Assurance CO
41190
Telk Sheet Metal Works, Inc.
Elba
INSURER C :
INSURER D:
PO Box 2156
INSURERE:
Loveland, CO 80538
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
LTR
rypE OF INSURANCE
ADDL
Ue
POLICY NUMBER
POLICY EFF
IMMUDDIYYYYI
POLICY EXP
[MMIDDtYYYY1LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMSJ'MDE 1K OCCUR
X Blkt Add'llns'd
5D06555
12I05/2013
12/05/2014
EACH OCCURRENCE
$ 1,000,00
DAMA E TO R N E
PREMISES Ea occurrence
$ 100,00
MED EXP (Any one person)
$ 5,00
PERSONAL$ ADV INJURY
$ 1,000,00
X
Blkt Wvr of Subr
GENERALAGGREGATE
$ 2,000,0010
GENL AGGREGATE LIMIT APPLIES PER:
X POLICY PRO -
IFCTn LOC
PRODUCTS - COMP/OP AGG
$ 2,000,0010
$
A
AU
TOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON-OWNEDAUTOS
5E06555
12/05/2013
12/05/2014
COMBINED SINGLE LIMIT
(Ea accident)
$ 1,000,00
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
X
PROPERTYE
(PER ACCIDENT)
$
X
X
Comp Ded
$ 50
Coll Ded
$ 50
UMBRELLA LMB
EXCESS LIAR
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
$
AGGREGATE
$
DEDUCTIBLE
RETENTION $
$
I
$
B
WORKERS COMPENSATION
AND EMPLOYERS'LIABILITY
ANY PROPRIETORIPARTNERIEXECUTIVE YIN
OFFICERIMEMBER EXCLUDED?
(Mandatory In NH)
If yes describe under
DESC RI PTION OF OPERATIONS below
NIA
4173269
04/30/2014
12/01/2014
WC STATU- OTH-
RY LIMITS I X E
E.L. EACH ACCIDENT
$ 1,000,00
E.L. DISEASE -EA EMPLOYEE
$ 1,000,00
E.L. DISEASE -POLICY LIMIT
$ 1,000,00
A
Property
5A06655
12/05/2013
12/05/2014
BPP 25,00
Ded 50
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remedios Schedule, If more space Is required)
If required by written contract or written agreement the certificate holder
is included as additional insured for ongoing operations.
FCUTILI
Fort Collins Utilities
Attn: Kaye Mathea
P.O. 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
V 1988-2U09 ACORD CORPORATION. All rights reserved.
ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD