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HomeMy WebLinkAboutINLET STRUCTURES INC - INSURANCE CERTIFICATE (2)_--meas OP ID: SS ,allka. o CERTIFICATE OF LIABILITY INSURANCE DAT3/111 015 03111 /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(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 . CONTACT PRODUCER Phone: 720-962-0930 NAME: Shaleen Martin Six 8 NE FAX Denverr Branch ac N ng Insurance Inc #a Fax: 720-962-0942 A/C No .303-653-0023 c Na : 720-962-0942 Br 225 Union Blvd. #575 ADDRESS: srnartin iX evin .cam Lakewood, CO 80228 PaooucER INLET-1 Sandra Aragon COST ER m . INSURED Inlet Structures Inc. INSURER A: Em to rs Mutual Casualty 21415 Danny & Rachel Garza INSURERS: Pinnacol Assurance 41190 5110 York Street Denver, CO 80216 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. pISR TYPE OF INSURANCE OLNSIR I WVQ BR POLICY NUMBER POLICY EFF POLICY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 DAMAGE TOR NTED PREMISES Ea occlmenu A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR X 3D23855 06102I2014 06/02/2015 $ 100,00 MED EXP (Arty one person) E 5,0001 PERSONAL 6 ADV INJURY $ 1,000, GENERAL AGGREGATE $ 2,000, PRODUCTS-COMP/OP AGG $ 2,000, GEN'L AGGREGATE LIMIT APPLIES PER: POLICY FXI PRO- LOC $ AUTOMOBILE LIABILITY A X ANY AUTO 3E23855 06/02/2014 06/02/2015 COMBINED SINGLE LIMIT (Ea acddent) $ 1,000,000 BODILY INJURY (Par person) $ ALL OWNED AUTOS $ BODILY INJURY (Per accident) SCHEDULED AUTOS HIRED AUTOS PROPERTY DAMAGE (Peraccident) $ $ _ NON -OWNED AUTOS 1 $ UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,00 AGGREGATE $ 5,000,00 A EXCESS LIAB CLAIMS -MADE 3J23855 06/02/2014 06/02/2015 DEDUCTIBLE $ X RETENTION $ 10,000 _ _ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? (Mandatory In NH) 4018512 N / A 'CO ONLY 04/01/2015 04/01/2016 X WC STATU- OTH- IORY LIMITS $ 1,000,00 E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEEI $ 1,000,00 K yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE- POLICY LIMIT I $ 1,000, DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) City of Fort Collins is named as additional insured as respects General Liability if required by written contract. I.cR I If-rliM I C r1VLUCR \ MII I.CLLN I IVIY CTYFT-1 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. P.O. Box 580 Fort Collins, CO 80522 AUTHORIZED REPRESENTATIVE ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD