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304997 BELFOR ENVIRONMENTAL INC - INSURANCE CERTIFICATE (5)
CERTIFICATE OF PROPERTY INSURANCE IDATE YYYY 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. PRODUCER CONTACT NAME: Aon Risk Services Central, Inc. PHONE FAX Southfield MI office (A/C. No. Ext): (866) 283 7122 (A/C. No.): (800) 363-0105 3000 Town Center E-MAIL ADDRE Suite 3000 PRODUCER 570000005415 Southfield MI 48075 USA CUSTOMERID#: INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A: Travelers Property Cas Cc of America 25674 Belfor Environmental, Inc. INSURER B: 5075 Kalamath Street INSURER C: Denver Co 80221 USA INSURER D: INSURER E: INSURER F: f'_(1VFRA(:FC r'F=PTIFIr'ATF NI IMRFR• 570077354363 RFVICI01NI NIIMRFR- LOCATION OF PREMISES/ DESCRIPTION OF PROPERTY (Attach ACORD 101, Additional Remarks Schedule, if more space is required) 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 POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YYYY) POLICY EXPIRATION DATE (MM/DD/YYYY) COVERED PROPERTY LIMITS A X PROPERTY CAUSES OF LOSS DEDUCTIBLES QT6309B112447TIL19 07/01/2019 07/01/2020 BUILDING PERSONALPROPERTY BUSINESS INCOME EXTRA EXPENSE RENTALVALUE BLANKET BUILDING BLANKET PERS PROP BLANKET BLDG & PP BASIC BUILDING BROAD X SPECIAL CONTENTS EARTHQUAKE WIND X $29,012.535 FLOOD Blkt B&PP Ded INLAND MARINE OF LOSS NAMED PERILS TYPE OF POLICY CAUSES POLICY NUMBER CRIME TYPE OF POLICY BOILER & MACHINERY / EQUIPMENT BREAKDOWN SPECIAL CONDITIONS / OTHER COVERAGES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION City of Fort Collins Attn: Purchasing Director Po Box 580 Fort Collins CO 80522 USA 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 © 1995-2015 ACORD CORPORATION. All rights reserved. ACORD 24 (2016/03) The ACORD name and logo are registered marks of ACORD L L; C 'C L d .D 0 x m l0 m v m t` n O ISE t\ ur1 W m Z W Q U LL F- Ir W U