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HomeMy WebLinkAbout130163 EMPIRE CARPENTRY LLC - INSURANCE CERTIFICATE (6)...i CERTIFICATE OF LIABILITY INSURANCE `,� DATE (MM0)014 10/14/2014 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 COWACT LINDA DECKER NAME: JOHN C. BECKETT & ASSOCIATES, INC. (P"AIc"xo E.,1: (970) 484-2805 FAX(AID, NoI9701 4e4-2885 220 Smith Street :oaEB, liada@beckettiasuraace.com PRODUCER CUSTOMER 0 F. EMPIRE CARPENTRY LLC 1 INSURER(_$) AFFORDING COVERAGE NAICR _ Ft. Collins CO 80524— INSURED h INSURER A :ADDISON FARMERS INS CO 10324 EMPIRE CARPENTRY LLC l v\ INSURER B INSURER C PO BOX 245 INSURER D INSURER E _ BELLVUE CO 80512-0245 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. IXSR LTR TYPE OF INSURANCE ADOLSIJSR IXSR WYD POLICY NUMBER POLICY EFF (MMIDDIYYYY) POLICY EXP IMNIpt)IYWY) LIMBS A GENERAL LIABILITY 16037e006 10/30/2014 10/30/2015 EACH OCCURRENCE $ 1000000 X COMMERCIAL GENERAL LIABILITY / / / / DAMAGE TO RENTED PREMISES Ea occurrence $ 100000 CLAIMS -MADE ® OCCUR / / / / MED EXP (Any one person) $ 5000 PERSONAL B ADV INJURY $ 1000000 GENERAL AGGREGATE $ 2000000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2000000 / / / / $ JECTX POLICY PRO LOC / / / / A AUTOMOBILE LIABILRY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS 60378006 10/30/2014 / / / / 10/30/2015 / / / / COMBINED SINGLE LIMIT (Ea accident) $ 1000000 BODILY INJURY (Per Person) $ BODILY INJURY (Per accident) $ X PROPERTY DAMAGE (Per accident) $ X X $ NON -OWNED AUTOS / / / / $ UMBRELLALIAR OCCUR O COVERAGE / / / / EACH OCCURRENCE $ AGGREGATE $ EXCESS DA9 CLAIMS -MADE / / / / DEDUCTIBLE is RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNERIE%ECUTVE OFFICERIMEMBER EXCLUDED? ❑ (Mandatory In NH) N/A NO COVERAGE / / / / / / / / WC STATU-II E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ It yes, descnC under DESCRIPTION OF OPERATIONS below / / / / E.L. DISEASE - POLICY LIMIT 1 $ 0 COVERAGE DESCRIPTION OF OPERATIONS I LOCATIONS I VENICLES (ANecX ACORD 101, Additional Remarks BcMduls, II mom spsu Is mi rinel) CERTIFICATE HOLDER CANCELLATION ( ) - (970) 221-6775 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. CITY OF FORT COLLINS PURCHASING DEPT. PO BOX 580 FORT COLLINS CO 80522-0580 AUTHORMED RREPRESENTATNE ACORD 25 (2009109) © 1988.2009 ACORD CORPORATION. All rights reserved. INS025 (200909) The ACORD name and logo are registered marks of ACORD