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HomeMy WebLinkAbout130163 EMPIRE CARPENTRY LLC - INSURANCE CERTIFICATE (7)" CERTIFICATE OF LIABILITY INSURANCE A�10/10//2018 Y) DATE(018 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 CONTACT Lisa Johnson NAME: 1 st American Fort Collins LLC H NN Ext : (970) 484-2805 IFAX a/C, No): (970) 484-2885 220 Smith Street ADDRESS: lisafc@laia.com INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: Addison Insurance Company 10324 Ft. Collins CO 80524 INSURED INSURER B : INSURER C : EMPIRE CARPENTRY LLC PO BOX 245 INSURER D : INSURER E : BELLVUE CO 80512-0245 INSURER F : COVERAGES CERTIFICATE N1IMPER: Master 2018-2019 REVIS!ON 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. IN LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 F;z_11 CLAIMS -MADE OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 _7 MED EXP (Any one person) $ 5,000 X PERSONAL 8 ADV INJURY $ 1,000,000 A 60378006 10/30/2018 10/30/2019 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO- X POLICY PRO LOC PRODUCTS - COMP/OP AGG $ 2,000,000 Liquor Liability Exclusion s OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY X AUTOS 60378006 10/30/2018 10/30/2019 BODILY INJURY (Per accdent) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED X AUTOS ONLY X AUTOS ONLY Uninsured Motorist $ 1,000,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE No Coverage DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N PER OTH- STATUTE ER E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? NIA No Coverage E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) If yes, describe under c_SCMPT,ON OFF OPERATIONS - -- - FOLICY urvd- - DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Proof of Insurance. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CITY OF FORT COLLINS PURCHASING DEPT. ACCORDANCE WITH THE POLICY PROVISIONS. PO BOX 580 AUTHORIZED REPRESENTATIVE FORT COLLINS CO 80521 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD