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HomeMy WebLinkAbout458509 WORKPLACE ELEMENTS LLC - INSURANCE CERTIFICATEACORO® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 12/21 /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 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 CoBiz Insurance, Inc. - CO 1401 Lawrence St., Ste. 1200 Denver CO 80202 CONTACT NAME: PHONE FAX arc No 303 988-0446 A/c No : 303-988-0804 ADDRIESS: COMail@cobizinsurance.com INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: Acadia Insurance Company 31325 INSURED WORKELE-W Workplace Elements, LLC 2501 Blake St INSURER B : Pinnacol Assurance Company 41190 INSURER C INSURER D : Denver CO 80205 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 1822771017 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. INSR LTR TYPE OF INSURANCE aDDL SUBR POLICY NUMBER POLICY EFF MM DD1YYYY POLICY EXP MMIDDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY Y CPA304003725 10/12018 10/12019 EACH OCCURRENCE $ 1,000,000 DAMAGE TRENTED CLAIMS -MADE X OCCUR PREMISES Ea occurrence $ 300,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 PRO- X POLICY X❑ JECT ❑ LOC EC PRODUCTS - COMP/OP AGG $ 2,000,000 1 $ OTHER: 1 A AUTOMOBILE LIABILITY CPA304003725 10/1r2018 10/12019 COMBINED SINGLE LIMIT Ea accident $ 1.000.000 BODILY INJURY (Per person) $ X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ NON -OWNED X HIRED AUTOS X AUTOS $ A X UMBRELLA LIAB X OCCUR CPA304003725 10/12018 10/12019 EACH OCCURRENCE $ 5,000,D00 AGGREGATE $ 5,000,000 EXCESS LIAB CLAIMS -MADE DED X RETENTIONS $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N 4128364 1/12019 1/1/2020 PER OTH- STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? ❑ N I A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,000 I E.L. DISEASE - POLICY LIMIT $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below i DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Subject to all policy terms and conditions. Citizens Carpet, Mountain Trade Supply and Block 32 Utility Administration Buildling are included as Additional Insured with respect to General Liability for Completed Operations when required by written contract per attached form. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Block 32 Utility Administration Building (UAB) ACCORDANCE WITH THE POLICY PROVISIONS. P.O. Box 580 215 N. Mason St. AUTHORIZED REPRESENTATIVE Fort Collins CO 80522Wa © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD