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HomeMy WebLinkAboutBIG HORN ROOFING INC - INSURANCE CERTIFICATEBIGHORN-37 ,ac c�Erc� CERTIFICATE OF LIABILITY INSURANCE DATE/Y os/16is/2oi8 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 BYTHE 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: Wyoming Financial Insurance PHONE FAX 400 E 1st St, Ste 105 A/C, No, Ext): (307) 473-3000 vc, No :(307) 265-3092 Casper, WY 82601 MSS: INSURERA:Allied Insurance Company of America 10127 INSURED INSURER B: Nationwide Mutual Insurance Company 23787 Big Horn Roofing Inc. INSURERC: 605 S Adams INSURER D : Laramie, WY 82070 INSURER E INSURER F : rn\/CD A/_CC /`C0TI1C11 ATC k111RA0CD• DC\/ICIr%kl KIIIMMr-0- 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 INS,WVDPOLICY NUMBER POLICY EFF POLICY EXP IDDIYYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR X X ACP3018312104 09/01/2018 09/01/2019 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED a occurrence $ 100,000 MED EXP (Any oneperson) 10,000 GEN'L PERSONAL 8 ADV INJURY $ 1,000,000 AGGREGATE LIMIT APPLIES PER: POLICY X PRCOT- 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 X ! X ACP3018312104 09/01/2018 09/01/2019 COMBINED SINGLE LIMIT Ea accident 1,000,000 $ BODILY INJURY Perperson) BODILY INJURY Per accident $ PROPERTY DAMAGE Per accident $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE X X ACP3018312104 09/01/2018 09/01/2019 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 DIED RETENTION $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/EXCLU R/EXECUTIVE u 7-1 $andaRIMEM NH) EXCLUDED? a andatory in NH) lives, describe under DESCRIPTION OF OPERATIONS below NIA A ACP3008312104 STOP GAP 09/01/2018 09/01/2019 PER X OTH- STATUTE ER E.L. EACH ACCIDENT 1,000,000 $ E.L. DISEASE - EA EMPLOYEE! 1,000,000 $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) When required by written contract or agreement, additional insured and waiver of subrogation applies under the General and Auto Liability per forms AC7006 03/16 , CG7246 11/15 (ongoing and completed operations) and CG7323 12/16. Coverage is primary and non contributory per form CG7323 12/16 and AC7006 03/16. Copies of such forms are available upon request. Umbrella will follow form as respects additional insured and waiver of subrogation. 30 Day Notice of cancellation applies to General Liability, Auto and Umbrella. I LOJ OI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Fort Collins THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Y ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 580 Fort Collins, CO 80522 AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD