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HomeMy WebLinkAbout102590 FRONT RANGE RAYNOR DOOR CO INC - INSURANCE CERTIFICATEFRRAY-1 OP ID"J DATE(MM/DDIYYYY) 05/14/2019 CERTIFICATE OF LIABILITY INSURANCE 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 endorsements . PRODUCER 970-482-7747 Brown 8: Brown Inc 4532 Boardwalk Dr, Suite 200 Fort Collins, CO 80525 Karen E. Siwek, CPA NONTACT Karen E. Siwek, CPA PHONE 970-482-7747 FAX 970-484-4165 (A/C, No, Ext): Arc, No): AD AIL• certi IcateS bbcolorado.com INSURERS AFFORDING COVERAGE NAIC # INSURER A: Union Insurance Company 25844 INSURED Front Range Raynor Door Co Inc INSURER B : Pinnacol Assurance Company 41190 3847 S Mason Street Fort Collins, CO 80525 INSURER C : INSURER D : INSURER E: INSURER F : COVERAGE CERTIFICATE NUMBER: 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 TYPE OF INSURANCE ADDL SUBR VVVD POLICY NUMBER POLICY EFF POLICY EXPLTR LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ^ OCCUR CPA3030684 06/01/2019 O6l01/2020 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RISES (E.ENTED $ 300,000 MED EXP (Any oneperson) $ 10,000 PERSONAL & ADV INJURY 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY —X jE LOC OTHER GENERAL AGGREGATE $ 2,000,000 PRODUCTS -COMP/OP AGG $ 2,000,000 A AUTOMOBILE LIABILITY X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY P CPA3030684 06/01/2019 06/01/2020 COMBINED SINGLE LIMIT 1,000,000 BODILY INJURY Perperson) BODILY INJURY Per accident $ PROPERTY DAMAGE Per accdent $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE CPA3030684 06/01/2019 06/01/2020 EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 DIED I I RETENTION $ B B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/M(Mandatory in ER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A 4052719 4052718 06/01l2019 06/01 /2019 06/01/2020 06/01/2020 X PER OTH- E.L. EACH ACCIDENT 1'000'000 E.L. DISEASE - EA EMPLOYEE 1,000,000 E L DISEASE - POLICY LIMIT 1,000 000 A Lease/Rent Equip CPA3030684 06/01/2019 06/01/2020 Limit Ded 50,000 1,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate Holder is included as an Additional Insured per policy forms and conditions CITYFC3 City of Fort Collins Purchasing Dept. P.O. 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 Karen E. Siwek, CPA ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD FRRAY-1 PAGE 2 NOTEPAD INSURED'S NAME Front Range Raynor Door Co Inc OP ID: JY Date 05/14/2019 When required by written contract or agreement the following may apply: General Liability: Additional Insured - Ongoing - Form CG 2010 0413 Additional Insured - Completed Operations - CG 2037 0413 Additional Insured - Owners, Lessees or Contractors - CG 2038 0413 Blanket Additional Insured - Ongoing - Form CL CG 0059 0916 Blanket Additional Insured - Completed Operations - CL CG 2062 0916 Blanket Waiver of Subrogation - Form CL CG 0059 0916 Primary and Non -Contributory - Form CG 2001 0413 Per Project Aggregate - Form CL CG 0059 30 Day Notice of Cancellation - IL 0017 1198 Automobile: Blanket Additional Insured - Form CW 3468 0215 Blanket Waiver of Subrogation - Form CW 3468 0215 Workers Compensation: Blanket Waiver of Subrogation - Form 359-B Umbrella is Follow Form over General Liability, Automobile Liability, and Employers Liability