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HomeMy WebLinkAboutINLET STRUCTURES INC - INSURANCE CERTIFICATEOP ID: SS '`III Ra CERTIFICATE OF LIABILITY INSURANCE DATE 81201YY osn6nola 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(les) 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 Phone: 720.962-0930 Insurance Inc #a Fax: 720-962-0942 Six v Gevir Branch Denver Branch 225 Union Blvd. #575 Lakewood, CO 80228 Nancy Kersey CONTACT NAME: Shaleen Martin IAINc°Nr o E :303.653-0023 ac No : 720.962.0942 ADDRESS: smartin@slx-geving.com PRODUCER .INLET-1 CUSTOMERID . INSURERS AFFORDING COVERAGE NAIC # INSURED Inlet Structures Inc. Danny & Rachel Garza P.O. Box 281 Platteville, CO 80651 INSURER A: Employers Mutual Casualty 21415 INSURER B : Pinnacol Assurance 41190 INSURER C : INSURER D : NSUMIR E: NSURERF: 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 TYPE OF INSURANCE ADDL a POLICY NUMBER MMIDD EFF MMLIC EXP LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR X 3D23855 06/02/2014 06/02/2015 EACH OCCURRENCE $ 1,000,00 PREMISES Ea occurrence $ 100,00 MED EXP (Arty one person) E 5,00 PERSONAL B ADV INJURY S 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PRa LOC PRODUCTS-COMP/OP AGG E 2,000,00 E A AUTOMOBILE LIABILITY ANV AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNEDAUTOS 3E23855 Ol /02/2014 O6IO2/2015 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,00 X BODILY INJURY (Per person) S BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ S S A UMBRELLA LIAR EXCESS LIVE X OCCUR CLAIMS MADE 3J23855 06/02/2014 06/02I2015 EACH OCCURRENCE S 5,000,00 AGGREGATE $ 5,000,00 DEDUCTIBLE RETENTION E 1 O 000 S X E B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY' ANY PROPRIETORIPARTNERIEXECUTNE YIN OFFICERMIEMBER EXCLUDED? �N (Mandatory In NH) It yea describe under DESCRIPTION OF OPERATIONS below NIA 4D16512 CO ONLY 04I91/2014 04/01/2015 X I WCSTATU- OTH- IMITER E.L. EACH ACCIDENT $ 1r000r00 E.L. DISEASE - EA EMPLOYEE E 1,000,00 E.L. DISEASE -POLICY LIMIT S 1,000,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional RemaAs Schedule, If more space Is required) City of Fort Collins is named as additional insured as respects General Liability if required by written contract. CTYFT-1 City of Fort Collins 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 ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD