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HomeMy WebLinkAbout267296 SELECT WOOD FLOORS INC - INSURANCE CERTIFICATESELEC-5 OP ID: AV ACORO° CERTIFICATE OF LIABILITY INSURANCE DATE1010202//2018 Y) 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 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 CONTANAME: Kaen E. Siwek, CPA Brown & Brown Inc 4532 Boardwalk Dr, Suite 200 PN"oNN Ell: 970-482-7747 C No): 970-484-4165 Fort Collins, CO 80525 E-MAIL Karen E. Siwek, CPA ss: ksiwek@bbcolorado.com INSURERS AFFORDING COVERAGE NAIC # INSURER A: Union Insurance Company 258" INSURED Select Wood Floors, Inc. INSURER 8: Pinnacol Assurance Company 41190 Attn: Kristy Janicki 225 N Lemay Ave,Ste 6 INSURER C Fort Collins, CO 80524 INSURERD: INSURER E : INSURER F : CnVFPAnFR CFRTIFICOTF NIIMRFR• RFVIRIAN NIIMRFR- 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 CONUII ION OF ANY GONI-RACT 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 INSURANCE ADDL U R POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR CPA3000812 10/01/2018 10/01/2019 EACH OCCURRENCE $ 1,000,00 DAMAGE TO RENTED PREMISES Ea occurrence $ 300,00 MED EXP (Any one person) $ 10,00 PERSONAL & ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ❑JECT PRO El LOC OTHER GENERAL AGGREGATE $ 2,000,00 PRODUCTS - COMP/OP AGG $ 2,000,00 Emp Ben. $ 1,000,00 A AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS CPA3000812 10/01/2018 10/01/2019 COMBINED SINGLE LIMIT Eaaccident $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Peraccident $ $ A UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE CPA3000812 10/01/2018 10/01/2019 EACH OCCURRENCE $ 1,000,00 AGGREGATE $ 1,000,00 DIED I X I RETENTION $ 0 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A 4110481 10/01/2018 10/01/2019 PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 500,00 E.L. DISEASE - EA EMPLOYEE $ 500,00 E.L. DISEASE - POLICY LIMIT $ 500'00 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) bonigkeit@poudre-fire.org POUDRFI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Poudre Fire Authority 102 Remington St Fort Collins, CO 80524 AUTHORIZED REPRESENTATIVE Karen E. Siwek, CPA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD SELEC-5 PAGE 2 NOTEPAD INSURED'S NAME Select Wood Floors, Inc. OP ID: AV Date 10/02/2018 If required by written contract the following apply on a blanket basis: General Liability CLCGO059 09 16 AdditionalInsured Ongoing Operations CLCG2062 09 16 Additional Insured Completed Operation CLCGO059 09 16 Per Project General Aggregate CLCGO059 09 16 Waiver of Subrogation CLCGO059 09 16 Primary 6 Non -Contributory applies Automobile CW3468 02 15 Additional Insured CW3468 02 15 Waiver of Subrogation CW3468 02 15 Primary 6 Non -Contributory applies ella owing Form rkers Compensation anket Waiver of Subrogation 359b