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HomeMy WebLinkAbout398103 B & W GLASS INC - INSURANCE CERTIFICATEB&WGLAS-01 JFLANAGAN ,acoRO CERTIFICATE OF LIABILITY INSURANCE �-/ O0/13/2 Y 14 0/1312014 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 Burns Insurance Agency, Inc PO Box 250 Burns, WY 820$3 CONTACT NAME: PHONE 307 547-3571 F'ix ac No Eat:( ) ac Ne: (307) 547-3573 ADDRIESS: INSURER(S) AFFORDING COVERAGE NAICN INSURER A:The Cincinnati Insurance Company INSURED INSURER a INSURER C B&W Glass, Inc. Tom Ludtke 2200 East 15th St. INSURER D INSURER E: Cheyenne, WY 82001 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 TYPE OF INSURANCE D R POLICY NUMBER POLICY EFF MM/DDIYYYY POLICY EXP MOLIC YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE OCCUR X X CPP1084110 10/14/2014 10/14/2015 PREMISESEacccunence $ 50,000 MED EXP (Any one person) $ 5,000 PERSONAL If ADV INJURY s 1,000,000 ,• .... GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE. - $ - 2,000,000 - r POLICY IFjECT LOC "' -' PRODUCTS-COMP70PAGG $ r"- 2,000,00 employers liab.- __. $ _. .1,000,000 a ___.._._ 'OTHER -' _..._,.. ... _ _ . ._... _ ' - AUTOMOBILE LIA6ILITY.----- _..____-.. ..__. .._�. __. ____._ .,_ _ .. __._ ._ _'_:. _':' _ _. _ . _ - �� ----- COMBINED SINGLE LIMIT Ea aaitlem -_ 8 _ _ 1,000,000 BODILY INJURY (Per person) $ A ANY AUTO X X CPP1084110 10/14/2014 1011412015 X ALL OWNED SCHEDULED AUTOS AUTOS X X NON-0&MED HIRED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,00 AGGREGATE 8 A EXCESS LIAB CLAIMSMADE X X CPP 1084110 10/14/2014 10/14/2015 DE X RETENTIONS 10,000 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORRARTNERIEXECUTIVE YIN OFFICER/MEMBER EXCLUDED? F1 (Mandatory in NH) NIA X CPP 1084110 , 10/14/2014 10/14/2015 IPER OTH- STATUTE X ER E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE -EA EMPLOYEE $ 1,000,000 It yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 1,000,000 A Property CPP 1084110 10/14/2014 10114/2015 Rented Equipment 60,000 A Property CPP 1084110 10/1412014 1011412015 Stored Material 150,00 DESCRIPTION OF OPERATIONS LOCATIONS VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) 1r l CFHI IF ICA IF HUI❑FH I-_— _. _. _- -.._ .._CANUIcIL•AI IUN—.-___.___—' 7,^ , _I - ...,, 1.1 . -� CITY OF FORT COLLINS---, AMBER DENOOY PO 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 r � © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD