HomeMy WebLinkAboutGILSDORF CANVAS & AWNING INC - INSURANCE CERTIFICATEi
AC"R,o CERTIFICATE OF LIABILITY INSURANCE
�-
DATE (MM/DD/YYYY)
09/06/2018
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 have ADDITIONAL INSURED provisions or 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
CONTAEr NAME: Trish PreUlt
PHONE (g70) 356-0123 (970) 330-1867
A/C No Et!I: A/C. No
Flood and Peterson
E-MAIL TPreuit@Floodpeterson.com
ADDRESS:
PO Box 578
INSURER(S) AFFORDING COVERAGE
NAIC 8
Greeley CO 80632
INSURER A: Ohio Casualty Insurance Company
24074
INSURED
INSURER B : Artisan and Truckers Casualty Co.
10194
INSURER C : Pinnacol Assurance
41190
Gilsdorf Canvas & Awning Inc
INSURER D :
410 S Summit View Dr
INSURER E :
INSURER F:
Fort Collins CO 80524
COVERAGES CERTIFICATE NUMBER: CL189625075 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.
ILTR
TYPE OF INSURANCE
INSD
WVD
POLICY NUMBER
MWDD/YYYY
MWDD/YYYY
LIMITS
x
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
CLAIMS -MADE � OCCUR
PREMISES Ea occurrence
$ 300,000
MED EXP (Any one person)
$ 15,000
PERSONAL & ADV INJURY
$ 1,000,000
A
BKO56763669
08/04/2018
08/04/2019
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 2,000,000
POLICY ❑ PROECT ❑ LOC
J
PRODUCTS - COMP/OP AGG
$ 2,000,000
PWTHE
$ 50,000
OTHER:
AUTOMOBILE LIABILITY
COMBINED SINGLELIMIT
(Ea accident
$ 1,000,000
BODILY INJURY (Per person)
$
ANY AUTO
B
OWNED SCHEDULED
AUTOS ONLY AUTOS
04431864-8
11/10/2017
11/10/2018
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
Per accident
$
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
I
PKG
$
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$
AGGREGATE
$
EXCESS LIAB
CLAIMS -MADE
FTDED
I I RETENTION $
$
C
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N
OFFICER/MEMBEREXCLUDED? ❑
(Mandatory in NH)
N/A
4163033
03/O1/2018
03/01/2019
PER OTH-
x STATUTE ER
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
E.L. DISEASE - POLICY LIMIT
1,000,000
$
If yes, describe under
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
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.
281 North College Avenue
AUTHORIZED REPRESENTATIVE
Fort Collins CO 80524 I ; / �z ;3WX—T/
01988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD