HomeMy WebLinkAboutMARTIN FIRE PROTECTION INC - INSURANCE CERTIFICATE74/3/2019
(MM!DD,YYYY)
ACORO® 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 endorsement(s).
PRODUCER CONTACT
NAME: Diahann L. Giorn0
GKS Insurance Agency PHONE 719-539-0144 FAX 719-539-4696
8044 W. Highway 50, #201 EMAIL
Salida CO 81201 ADDRESS: dgiornoLborsdenver.com
INSURED
Martin Fire Protection, Inc.
12295 Pennsylvania Street, #4B
Thornton CO 80241
IN$URER($�AFFORDING C
INSURER A! Lloyd's of London
MARTI-5 INSURERB: Westfield Insurance
INSURER C : Pinnacol Assurance
COVFRAGFS CFRTIFICATE NUMBER 1.55R277odA REVISION NUMBER:
NAIC #
24112
41190
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;----__.____ _-------- �OL'.SURt --�r POLICY EFF' POLICY EXP
LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY D/YYYY LIMBS
A
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE U OCCUR
FSG000428-01
4/1/2019
411/2020
EACH OCCURRENCE
A7�AAGETbR NTEb
PFjFMISESs 99 2cqurr$tc�e)
$1.000,000
$100,000
--0 --
MED EXP (Any one rson_
$ 5,000
X E&O E# InUuded
PERSONAL & ADV INJURY
$1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 2,000,000
POLICY X uPRO- LOC
! PRODUCTS _ COMP/OP AGG
$ 2 000 000
OTHER:
$
B
AUTOMOBILE LIABILITY
CWP1096222
4/1/2019
4/1/2020
COMBINEDSIN LIMIT
@rci en—
$1,000,000
BODILY INJURY (Per person)
$
X ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
$
X HIRED X NON -OWNED
AUTOS ONLY AUTOS ONLY
A
X UMBRELLA LIAR
X
OCCUR
FS0000194-01
4/1/2019
4/1/2021
EACH OCCURRENCE
$ 2,000,DD0
EXCESS LIAB
CLAIMS -MADE
AGGREGATE
$ 2,000,000
DED ' X ' RETENTION $
$
C WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANYPROPRIETORIPARTNEPEXECUTIVE
4149255
4I1/2018
4/1/2020
PER OTH-
1STATUTE_EA
—?
E.L. EACH ACCIDENT
1
—
$1,000,000
OFFICER/MEMBEREXCLUDED? ❑
(Mandatory In NH)
N/A
E.L. DISEASE EA EMPLOYEE
J
—
$1,000,000
y
If yes, desrribe under
' DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
B Inland Marine
CVVP1098222 4/1/2019 4/1/2020 50,000 500 Deductible
Leased & Rented Equip
I
I
DESCRIPTION OF OPERATIONS I LOCATIONS; VEHICLES (ACORD 101, Additional Remarks Schedule. may be attached if more space is required)
All policy terms, conditions and exclusions apply.
r I=RTIFIr:ATF 14ni nFR CANCELLATION
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
300 LaPorte Avenue
AUTHORIZED REPRESENTATIVE
Fori Collins CO 80521
01988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
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