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HomeMy WebLinkAboutPROVINCE CUSTOM BUILDERS INC - INSURANCE CERTIFICATEA`CORa►® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/2018 Y) ,1/02/0,8 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 Moody Insurance Agency, Inc. 8055 East Tufts Avenue Suite 1000 Denver CO 80237 CONTACT NAME: Christine Walker, CISR, CRIS AICNIJ Ext : (303) 824-6600 FAX,(AIC No): (303) 370-0118 E-MAIL ADDRESS: chr stine.walker@moodyins.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Colony Insurance Company 39993 INSURED Province Custom Builders, Inc. Province, Inc. PO BOX 399 Windsor CO 80550 INSURER B : Ohio Security Insurance Company 24082 INSURER C : Pinnacol Assurance 41190 INSURER D : American Zurich Insurance Co 40142 INSURER E : INSURER F : CnVFRAnFA CERTIFICATE NUMRFR! 18/19 Master COI 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 MMIDDY/YYYY MM DD/YYYY 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 PERSONAL BADVINJURY $ 1,000,000 A 103GL001161103 11/01/2018 11/01/2019 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY ❑ PRO- ❑ LOC JECT PRODUCTS - COMP/OPAGG $ 2,000,000 $ OTHER- AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ ANY AUTO B OWNED X SCHEDULED AUTOS ONLY AUTOS X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY BFS56366233 11/01/2018 11/01/2019 BODILY INJURY (Pe accident) $ PPROPERdT ant) $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 AEl EXCESS LIAB CLAIMS -MADE XS173896 11/01/2018 11/01/2019 AGGREGATE $ 2,000,000 DIED I X1 RETENTION $ 0 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) NIA 4160607 11/01/2018 11/01/2019 PER ER !� STATUTE ER E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYEE $ 100,000 E.L. DISEASE - POLICY LIMIT $ 500,000 If yes, describe under DESCRIPTION Or CPERATIONS below Building Limit $3,000,000 D Builders Risk Replacement Cost/Special Form BR71587119 11/28/2018 11/28/2019 Location Limit $5,000,000 Deductible $1,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTI 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 N College Ave AUTHORIZED REPRESENTATIVE Fort Collins CO 80524 I © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 26 (2016/03) The ACORD name and logo are registered marks of ACORD COMMENTS/REMARKS CONTRACTUAL LIABILITY APPLIES PER POLICY TERMS AND CONDITIONS General Liability: CG 20 10 04 13 Form Attached Includes: Blanket Additional Insured status applies only to the extent provided in form CG 20 10 04 13 when required by written contract. Primary and Non -Contributory status only to the extent provided in form CG 20 01 04 13 when required by written contract. U047-0310 Form Attached Includes: Blanket Waiver of Subrogation applies only to the extent provided in form U047-03109 when required by written contract. UCG 25 03 10 13 Form Attached Includes: Per Project Aggregate Limit applies only to the extent provided in form UCG 25 03 10 13 when required by written contract. IMPORTANT: The policy forms referenced will be sent via email only. To obtain copies, please send your request with the email address to certrequest@moodyins.com l OFREMARK COPYRIGHT 2000, AMS SERVICES INC. I