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HomeMy WebLinkAbout432987 MBI CONSULTING LLC - INSURANCE CERTIFICATE (9)MBICO-1 OP ID: JN , k. o CERTIFICATE OF LIABILITY INSURANCE �/ o01/2AM /2015 ) 01 /27/2015 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 PFS Insurance Group -JT 4848 Thompson Pkwy, Ste 200INC.No Johnstown, CO 80534 Johnstown Select Accounts CONTACT NAME: PHONE FAX Exe: ac No: E4AA1L ADDRESS: INSURERS AFFORDING COVERAGE NAIC k INSURERA: EMC Insurance Companies 21415 INSURED MBI Consulting, LLC INSURER B: Pinnacol Assurance Co 41190 PO Box 2085 Fort Collins, CO 80522 INSURER C: INSURER D : INSURER E: INSURER F: COVFRAr.FS 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 ADDLSUBR POLICY NUMBER MM/DDY� MMLODNYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR X 31384658 BLANKET ADD'L INSURED 02/0412015 02/04/2016 EACH OCCURRENCE $ 1,000,00 PREMISES Ea occurrence $ 60,00 MED EXP (Any one Person) $ 5,00 PERSONAL $ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- LOC JECT PRODUCTS - COMPIOP AGG $ 2,000,00 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS HAUTOS SINGLE LIMIT Ea accident (Ea $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE PER ACCIDENT $ UMBRELLA LIAR EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DELI I I RETENTIONS I $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORRARTNERIEXECUTIVE YIN OFFICERIMEMBER E%CLUDEDT (Mandatory In NH) If yea, daswine uMer DESCRIPTION OF OPERATIONS below N I A 4106693 07/01/2014 07/01/2016 X I WC STATU- OTH- MER El EACH ACCIDENT $ 100,00 E.L. DISEASE -EA EMPLOYEE $ 100,00 E.L. DISEASE -POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remerlu Schedule, It moro spas- Is roqulrad) All Locations / All Operations CERTIFICATE HOLDER CANCELLATION CITYOF3 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 580 AUTHORIZED REPRESENTATIVE Fort Collins„ CO 80522 ACORD 25 (2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD