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HomeMy WebLinkAboutMB ROOFING INC - INSURANCE CERTIFICATEMBROO-2 OF ID: E1 'A4C "Rix CERTIFICATE OF LIABILITY INSURANCE DAT02127DI/15YYYY) 2/27 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 303-980-6265 CONTACT NAME: Evie Jo Ontiveros Brown & Brown of Colorado, Inc 5142 2170 S. Parker Rd Ste 251 720-962- Denver, CO 80231 Jason Sartor PHONE 720 4286 FAX A/c Na -963 A/C No: 720-962-5142 E-MAIL ADDRESS: eontiveros@bbdenver.com INSURE S AFFORDING COVERAGE NAIC 0 INSURER A: Secura Insurance Co. 22543 INSURED MB Roofing Inc. INSURER 8: Pinnacol Assurance Company 41190 P.O. Box 1289 Commerce City, CO 80022 INSURERC: NATIONAL UNION FIRE INS. CO. 19445 INSURER o : Knight Specialty Ins Company 15366 INSURER E : Rockhill Insurance Co 28053 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 INSURANCEADDL POLICY NUMBER POLICY EFF MM/DD/Y1'YY POLICY EXP MMIDD/YYYY LIMITS D GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE L7 OCCUR X KSVENA150001800 03/01/1$ 03/01/16 EACH OCCURRENCE $ 1,000,00 DAMAGE TO RENTED PREMISES Ea occurrence $ 100,00 MED EXP (Any one person) $ 5,00 PERSONAL B ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PRO- LOC PRODUCTS - COMPIOP AGG $ 2,000,00 $ A AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS A3174667 03/01/15 03/01/16 COMBINED SINGLE LIMIT Ea aoddent 11000,000 BODILY INJURY (Per person) $ BODILY INJURY (Par accident) $ PROPERTY DAMAGE Per accident $ C. UMBRELLA LIAB E%CF LWB X OCCUR CLAIMS -MADE SE068404530 03/01/15 03/01/16 EACH OCCURRENCE $ 1,000,00 X AGGREGATE $ 1,000,00 DED X I RETENTION $ 0 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITYFIR ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? � (Mandatory in NH) M yyes, describe under OF.SCRIPTION OF OPERATIONS below N I A 27282 03/01/15. 03/01/115 X WC STATU- OTH- E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYEE1 $ 1,000,00 E.L. DISEASE -POLICY LIMIT $ 1,000,00 A E Le/Re & Inst Float Pollution Liabilit CP3174666 ENVP00780301 03/01/15 03/01/15 03/01/16 03/01/16 L/R&Insta 100,00 Poll Liab 1,000,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Per policy terms, conditions and exclusions. City of Fort Collins is an additional insured for General Liability as required by written contract. FTCOLLC City of Fort Collins PO Box 580 Ft Collins. CO 80526 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 © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD