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HomeMy WebLinkAbout113298 EDWARDS REFRIGERATION - INSURANCE CERTIFICATEEDWA-19 'ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 03/27/2019 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 CONTACT Karen E. Siwek, CPA NAME: Brown 8r Brown Inc PHONE 970-482-7747 FAX 970-484-4165 4532 Boardwalk Dr, Suite 200 (A/C, No, Ext): A/C, No): Fort Collins, CO 80525 E-MAADDRIL . certificates@bbcolorado.com K5ren E. Siwek, CPA INSURER A:Pinnacol Assurance Company 41190 INSURED G.A.S. of Fort Collins, Inc INSURER B: Westfield Insurance Company 24112 dba Edwards Refrigeration 6712 N. Franklin Ave INSURER C Loveland, CO 80538 INSURER D : rnvCOArrc r`00rI01!`Ar0 All 1RA000- 0C\/ICIr1A1 Alt IMQCC- 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 ADDLHiqn;SUBR Vrvn POLICY NUMBER POLICY EFF POLICY EXPLTR LIMITS B X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE " OCCUR Y CWP0343063 04/06/2019 04/06/2020 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED $ 500,000 MED EXP (Any oneperson) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X JEeT LOC OTHER GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 B AUTOMOBILE LIABILITY X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS p AUTOS ONLY AUOTOSONLY Y CWP0343063 04/06/2019 04/06/2020 COMBINEDtSINGLE LIMIT $ 1,000,000 BODILY INJURY Perperson) $ BODILY INJURY Per accident _ P�2r. ,dZDAMAGE er accdent $ B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE CWP0343063 04/06/2019 04/06/2020 EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 DED X RETENTION $ O A WORKERS COMPENSATION AND EMPLOYERS' LIABILITYSTATUTE OOFFICENY R/MEMBER/PARTEXCLUDED?ECUTIVE ❑ (Mandatory in NH) If yes, describe under E CRIPT'ON OF OPERATION below N/A 4070426 10/01/2018 10/01 /2019 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 B Install Floater CWP0343063 04/06/2019 M0612020 Limit Ded 15,000 500 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) City of Fort Collins is included as additional insured on the general liability if required by written contract. CITYFT7 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Fort Collins Community Development PO Box 580 AUTHORIZED REPRESENTATIVE Fort Collins, CO 80522-0580 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 EDWA-19 PAGE 2 NOTEPAD INSURED'S NAME G.A.S. of Fort Collins, Inc OP ID: JY Date 03/27/2019 The following apply if required by written contract: Commercial General Liability: Blanket Additional Insured - Ongoing Operations - Form CG 2010 Blanket Additional Insured - Completed Operations - Form CG 2037 Primary and Non -Contributory Coverage - Form CG 7137 Blanket Waiver of Subrogation - Form CG 7137 Per Project Aggregate - Form CG 2503 Commercial Automobile: Blanket Additional Insured - Form CA 7077 Blanket Waiver of Subrogation - Form CA 0444 Workers Compensation: Blanket Waiver of Subrogation - Form 359B Umbrella is follow form