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Home My WebLink About102529 R & R BLACKS GLASS INC - INSURANCE CERTIFICATE (2)OP ID: CT CERTIFICATE OF LIABILITY INSURANCE 1 DATE 12/02/20 4 ) 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 Phone:970-223-1804 CONTACT NAMEPHONE VolkBell Property &Casualty 1100 Haxton Dr. Suite #100 Fax: Fort Collins, CO 80525 Steven G. Smith FA% AIc No Exit), ac Ne E-MML ADDRESS: PRODUCER R&RBL-1 CUSTOMER ID#: INSURER(S) AFFORDING COVERAGE NAIL# INSURED R & R Blacks Glass, Inc. INSURERA-Secure Insurance Companies 22543 ID#344424 360 Jefferson Street INSURER e:PinnacolAssurance 41190 Ft. Collins, CO 80524 INSURER C: INSURER D : INSURER E : 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 OL UBR POLICY NUMBER MMMDYIYYYY MMIDDYIY YY LIMITS A GENERAL LIABILITY X COMMERCIALGENERALUABILITY CLAIMS -MADE 1 OCCUR X TC003156729 12110/2014 12/1012015 EACH OCCURRENCE $ 1,000,000 PREMISES E...renae $ 100,000 MED EXP (Any one Person) $ 5,000 PERSONAL &ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE UMIT APPLIES PER: X POLICY PRO- LOC PRODUCTS - COMP/OP AGG $ 2,000,00 EPLI $ 100,00 A A A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS A3156730 A3156730 IA3156730 12/10/2014 12/1012014 12/1012014 12110/2015 12/1012015 12/1012015 COMBINED SINGLE LIMIT (Ea accident)BODILY $ 1,000,00 INJURY(Per person) $ BODILY INJURY(Per accident) $ PROPERTY DAMAGE (Per accident) $ JX $ E A X UMBRELLA Like EXCESS LUIB X OCCUR CLAIMS -MADE CU3156731 12110/2014 12/1012015 EACH OCCURRENCE S 1,000,00 AGGREGATE $ 1,000,000 DEDUCTIBLE RETENTION $ _10,000 $ X $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETORIPARTNERIEXECUTNE OFFICERIMEMBER EXCLUDED? ❑ (Mandatory In NH) If yea, desmbe under DESCRIPTION OF OPERATIONS below N/A 4079578 07/011204 07/01/2015 X WC STATU- OTH- T RV IMIT ER E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,00 E.L. DISEASE - POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (Anach ACORD IOI, AddMo.I R..aM Schedule, If mor...... le re ]red) Holder is listed as an additional insured with regards to the Genera Liability policy. City of Fort Collins PO Box 580 Fort Collins, CO 80522 CITY OF 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 ACORD 25 (2009/09) © 1988.2009 ACORD The ACORD name and logo are registered marks of ACORD reserved.