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HomeMy WebLinkAbout130163 EMPIRE CARPENTRY LLC - INSURANCE CERTIFICATE (9)i 1 ® A�coR� CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 10/10l2018 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 1st American Fort Collins LLC 220 Smith Street Ft. Collins CO 80524 CONTACTLisa Johnson PNHONN Ext . (970) 484-2805 A/C NO), (970) 484-2885 E-MAIL lisafc@laia.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: Addison Insurance Company 10324 INSURED EMPIRE CARPENTRY LLC PO BOX 245 BELLVUE CO 80512-0245 INSURER B : INSURERC: INSURER D : INSURER E INSURER F ovFRlau^ES ^':�I�'C."�� •'S;'!Srr . ntaetFr')n1g-2()1Q taGyictON NUNlgt:ra• 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. I�TR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM DD/YYYY) (MMDDIYYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE OCCUR PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ 5,000 A Y 160378006 10/30/2018 10/30/2019 X PERSONAL & ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 X POLICY PRO-- LOC JECT PRODUCTS - COMP/OPAGG $ 2,000,000 Liquor Liability Exclusion $ OTHER. AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS 60378006 10/30/2018 10/30/2019 BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED XAUTOS ONLY AUTOS ONLY IX Uninsured Motorist $ 1,000,000 UMBRELLA LJAB OCCUR EACH OCCURRENCE $ HCLAIMS-MADE AGGREGATE $ EXCESS LIAB No Coverage DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N PER OTH- STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ NIA No Coverage E.L. EACH ACCIDENT $ (Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $ If yes. describe under DESCRIPTION OF OPERATIONS elow F I. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER IS ADDITIONAL INSURED PER WRITTEN CONTRACT ON THE GENERAL LIABILITY FOR THE ONGOING OPERATIONS OF THE NAMED INSURED. 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 ACCORDANCE WITH THE POLICY PROVISIONS. 215 NORTH MASON ST AUTHORIZED REPRESENTATIVE PO BOX 560 FT. COLLINS CO 80522�<_._. ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 26 (2016/03) The ACORD name and logo are registered marks of ACORD