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HomeMy WebLinkAbout414575 MAXIMUM PAINTING LLC - INSURANCE CERTIFICATE (2)A�ROF CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNYYY) 04/15/2019 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 endorsement(s). PRODUCER CONTACT Shannon Kammerer NAME: Flood and Peterson PHONE (970) 356-0123 FAX (970) 330-1867 A/C No Ext : A/C No PO Box 578 E-MAIL SKammerer@floodpeterson.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: Westfield Insurance Company 24112 Greeley CO 80632 INSURED INSURER B : Pinnacol Assurance 41190 Maximum Painting, LLC INSURER C : INSURER D : 412 S. Howes St., Ste. C INSURER E : INSURER F : Fort Collins CO 80521 COVERAGES CERTIFICATE NUMBER: x12/1/18-19 Master 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 AUULIbUBR INSD WVD POLICY NUMBER POLICY EFF MMIDD POLICY EXP MMIDDNYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE ® OCCUR DAMAGE TO RENTE7_ PREMISES Ea occurrence s 500.000 MED EXP (Any one person) $ 5,000 PERSONAL& ADV INJURY s 1,000,000 A TRA3290427 12/01/2018 12/01/2019 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY © JECTPRO ❑ LOC PRODUCTS - COMPIOP AGG $ 21000,000 Employee Benefits S 1,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident S 1,000,000 BODILY INJURY (Per person) $ ANY AUTO A OWNED SCHEDULED AUTOS ONLY AUTOS TRA3290427 12/01/2018 12/01/2019 BODILY INJURY (Per accident) S PROPERTY DAMAGE Per accident S HIRED NON -OWNED AUTOS ONLY AUTOS ONLY Underinsured motorist s 1,000,000 UMBRELLA LIAB OCCUR ..�"'8""U _'"�" i, EACH OCCURRENCE 5,000,000 $ AGGREGATE s 5,000,000 A EXCESS LIAB CLAIMS -MADE TRA3290427 12/01/2018 12/01/2019 DED I X1 RETENTIONS O S B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVEN OFFICERlMEMBER EXCLUDD ED? (Mandatory In NH) l A 4104129 05/01/2019 OS/O1/2020 PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE S 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1,000,000 S Limit DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Certificate holder is included as Additional Insured as required by written contract with respects to liability arising out of work performed by the named insured, respects to the Auto Liability and General Liability policies. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS. P.O. Box 580 AUTHORIZED REPRESENTATIVE Fort Collins CO 80522 NP/i2/i_' ,�ff,�ZZ/GQ�i�I © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD