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Home My WebLink AboutBUILDER SERVICES GROUP INC DBA MATO - INSURANCE CERTIFICATE4co�zv® CERTIFICATE OF LIABILITY INSURANCE ". DATEIM09I2612014I2014YY) 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 endomement(s). PRODUCER A00 Risk services Central, Inc. Southfield MI office CONTACT NAME: PHONE (966) 283-7122 FAX 800-363-0105 INC. N..Ep: AID. No.): E44AL ADDRESS: 3000 Town Center Suite 3000 Southfield MI 48075 USA INSURER(S) AFFORDING COVERAGE NMCa INSURED INSURER A: old Republic Insurance Company 24147 Builder Services Group. Inc. d/b/a Mato 4850 Lima street INSURER B: Indemnity Insurance CO of North America 43575 INSURER C: ACE American insurance Company 22667 Denver CO 80239 USA NSURER O: ACE Fire underwriters Insurance Co. 20702 N9URERE: INSURER F: COVERAGES CERTIFICATE NUMBER: 570055288835 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. Limits shown are as requested INSIR TYPE OF INSURANCE INSC MID POLICY NUMBER M M D LIMITS A MWZV EACH OCCURRENCE 52, 000,000 1COMMERCUU-CIENERALLIABILIfTY 0.AIMS-MADE X❑OCCUR PREMISES Ea ocarrenca $2,000, 000 MED EXP(My p p n) $25,000 PERSONAL B ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $510001000 PR0. % POLICY � JECT LOC PROOUCTS - COAPIOP AGG $10, 000, OOO OTHER: A AUTOMOBILE LIABILITY MWT13 18398-14 06/30/201406/30/2015 COMBINED SINGLE LIMIT Ea awdeno $5,000,000 BODILY IWURY (Pw,.n) % ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS X HIREDAUTOS X NON -OWNED AUTOS BODILY IWURY(P. amiden0 PROPERTY DAMAGE Per xadem UMBRELLALLIB OCCUR EACH OCCURRENCE EXCESS LMB CLAIMS -MADE AGGREGATE DED RETENTION B O WORKERS COMPENSATION AND EMPLOYERS'LABILITY YIN ANY PROPRIETOR I PARTNER I EXECUTIVE OFFICERIMEMBER EXCLUDED? N NIA WLRC47888414 Deductible - ADS WLRC47888402 06 30/2014 06/30/2014 06/30/2015 06/30/2015 PER OTH- X STATUTE E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE.EA EMPLOYEE $1,000,000 (MandMory In NH) If Y dea . u,Mer DESCRIPTION OF OPERATIONS O Iow Ded - CA, MA E.L. DISEASE -POLICY LIMT S110001000 c Excess WC - WCUC47888438 Self -Insured States 06/30/2014 06/30/2015 Retention Statutory $2,000,000 Included SIR applies per policy to s & condi ions DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, AddWonel Remarks SPHBdule, may De aaa.hed If more space la required) [Prof: RE: Project Name: First Principle Homes Inc.]. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL SE DELIVERED N ACCORDANCE WITH THE POLJCYPRMMIONS. City Of Ft. Collins Attn: insurance Administration AUTHOWED REPRESENTATIVE Ft. La orte Ft. CDl line Avenue, Bldg. e CO Avenue, 80521 USA 01988-2074 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD E. AGENCY CUSTOMER ID: 570000027887 LOC #: ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY Aon Risk services Central, Inc. NAMED INSURED Builder Services Group, Inc. POLICY NUMBER See Certificate Number: 570055288835 CARRIER See certificate Number: 570055288835 NAIC CODE EFFECTIVE DATE. ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance INSURER(S) AFFORDING COVERAGE NAIC # INSURER INSURER INSURER INSURER ADDITIONAL POLICIES If a policy below does not include limit information, refer to the corresponding policy on the ACORD certificate foml for policy limits. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFFEC WE DATE MMIDDn'VY1 POLICY' EXPIRATION DATE MMn1DAW LIMITS WORKERS COMPENSATION D N/A SCFC4788844A WI Only 06/30/2014 06 30/2015 B N/A WLRC47888426 Tx only 06/30/2014 06/30/2015 ACORD 101 (2008/01) ® 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD '4� �® CERTIFICATE OF LIABILITY INSURANCE OATE(MMIDD Y Y) 09126/20DZ 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 endomemenf(s). PRODUCER AOn Risk Services Central, Inc. Southfield MI office CONTACT NAME:PHONE (g66) 283-7122 FAX 800-363-0105 (AC.N..Eatl: AC. Na.: 3000 Town Center Suite 3000 SMAIL ADDRESS: Southfield MI 48075 USA INSURER(S) AFFORDING COVERAGE NAIC e INSURED WSURERA old Republic Insurance Company 24147 Builder Services Group. Inc. - d/b/a Mato 4850 Lima Street INSURER B: Indemnity Insurance CO Of North America 43575 INSURER C: ACE American Insurance company P Y 22667 Denver Co 80239 USA INSURER D: ACE Fire underwriters Insurance Co. 20702 !SURER E: NSURER F: COVERAGES CERTIFICATE NUMBER: 570055280671 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. Limits shown am as requested INSIR Try TYPE OF INSURANCE INSD WVD POLICY NUMBER M IUUCYE M D LIMITS A X I WMMERCIALGENERA.LIMUJTY MwZY EACH OCCURRENCE $2,000,000 CIAIMS-MADE X❑OCCUR PREMISES E. om,rmnce $2, 000, 000 MED EXP W, mw peraon1 $25,000 PERSONAL&AOV INJURY $2,000,006 GEN'L AGGREGATE LINT APPLIES PER: GENERAL AGGREGATE $5,000,000 % POLICY �JECT ❑ LOC PRODUCTS -CONWIOP AGG $10, 000, 000 OTHER: A AUTOMOBILE LIABILITY MWTB 18398-14 06/30/2014 06/30/2015 COMBINED SINGLE LIMB $5,000,000 BODILY INJURY (Per pemon) X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS X NON-O X HIRED AUTOS WNED AUTOS BOOILV INJURY iPer acdden0 PROPERTl DAMAGE Por ecdtlent UMBRELLALMB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS -MADE AGGREGATE MD I RETENTION B C WORKERS COMPENSATION AND EMPLOYERS' LIABILJTY YIN My OFFICERIMEMBERI PARTNERI EW EXECUTIVE EN] NIAWLRC47888402 WLRC47888414 Deductible - AOS % 30 2014 06/30/2014 Ofi 30 261S 06/30/2015 PER OTH- X STATUTE E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE -EA EMPLOYEE $1,000,000 (Mandatory In Nil) Ded - CA, MA If deaodneunder DESCRIPTION OF OPERATIONS UeImv E.L. DISEASE -POLICY LIMIT $1,000,000 * Excess wC WCUC47888438 O6/30/2014 06/30/201S Retenti On $2,000,000 Self -Insured States Statutory Included] SIR applies per policy ter s & condi ions DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, MmUonal Remarks SCIsdYN, may Ie adacMd If more spew Is requmad) [Proj: RE: Project Name: Police Department]. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVERED IN ACCORDANCE WITH THE POUCYPROVISIONS. City Attn: Of Fort Collins Insurance Administrator AMHORQED REPRESENTATIVE Fort For Laporte Ave., Building B Collins Co 80ui USA s ®1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 570000027887 LOC #: ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY NAMED INSURED ADD Risk Services central, Inc. Builder Services Group, Inc. POLICY NUMBER See Certificate Number: S70055280671 CARRIER NAIC CODE See certificate Number: 570055280671 EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance INSURER(S) AFFORDING COVERAGE NAIC # INSURER INSURER INSURER INSURER ADDITIONAL POLICIES If a policy below does not include limit information, refer to the corresponding policy on the ACORD certificate form for policy limits. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR AND POLICY NUMBER POLICY EFFECTIVE DATE MM1I/DDh'ri' POLICY EXPIRATION DATE MM/OD/YY LIMITS WORKERS COMPENSATION p N/A scFc4788844A WI Only 06/30/2014 06/30/2015 g N/A WLRC47888426 T% Only 06/30/2014 06/30/2015 ACORD 101 (200af01) 02008 ACORD CORPORATION. All rights reserved. The ACORD new and logo are registered marks of ACORD