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HomeMy WebLinkAbout130163 EMPIRE CARPENTRY LLC - INSURANCE CERTIFICATE (10)l � O® A v CERTIFICATE OF LIABILITY INSURANCE DATE /IYYYY) 05/2020/202019 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 terns 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 Pinnacol Assurance 7501 E. Lowry Blvd. Denver, CO 80230-7006 CONTACT NAME: -- PHONE FAX rnrr. No Eztl; A/C No): EMAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A:PInnacolAssurance 41190 INSURED INSURER B : INSURERC: Empire Carpentry LLC 204 Commerce Drive, Unit H Fort Collins, CO 80524 INSURERD: INSURER E : INSURER F : /1c0TICIf1ATC nUIURFR- REVISION NUMBER: VVVCRMVGJ vim.. •• vr..� ......... �... 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 S BR POLICY NUMBER MM/DDtYYYY MM/DD EXP LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE -I $ CLAIMS -MADE Ll OCCUR A G U REN PREMISES Ea occurrence $ MED EXP (Any one person) $ _ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ POLICY PRO- LOC JECT $ OTHER: AUTOMOBILE LIABILITY COMB identSINGLE LIMIT accident) $ BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY (Per accident) $ OWNED SCHEDULED AUTOS ONLY _ AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS L1AB CLAIMS -MADE DED I I RETENTION $ WORKERS COMPENSATION PER OTH X I STATUTE ER $ E.L. EACH ACCIDENT $ 100+000 A AND EMPLOYERS' LIABILITY IANYPROPRIETOR/PARTNER/EXECUTIVE Y❑ OFFICERIMEMBEREXCLUDED9 (Mandatory in NH) N/A 1519590 09/01/2018 09/01/2019 E.L. DISEASE - EA EMPLOYEE $ 100 000 E.L. DISEASE - POLICY LIMIT $ 500,000 If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Unless otherwise stated in the policy provisions, coverage in Colorado only. CEKI IFIGA I t HULL1tK 1993929 City of Fort Collins Po Box 580 Fort Collins, CO 80522 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Pinnacol Assurance V -1 V00-AU I ALVRv %,%jnr Wn r rv.•. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD ACORDs provided by Forms Boss. www.FormsBoss.com; (c) Impressive Publishing 800-208-1977