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HomeMy WebLinkAboutBUILDER SERVICES GROUP INC DBA MATO - INSURANCE CERTIFICATE (2)�1 ao A�Ro CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 06/06/2019 I 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 poficy(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 AOn Risk Services Central, Inc. Southfield MI Office CONTACT NAME: (A/C. o.Ext): (866) 283-7122 (aC.No.: (800) 363-0105 E-MAIL ADDRESS: 3000 Town Center Suite 3000 INSURER(S) AFFORDING COVERAGE NAIC # Southfield MI 48075 USA INSURED INSURER A: ACE American Insurance Company 22667 Builder Services Group, Inc. INSURER B: Old Republic Insurance Company 24147 d/b/a Mato A TopBuild Company INSURER C: Lloyd's Syndicate No. 1969 AA1120106 INSURER D: 4275 Forest St Denver CO 80216 USA INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570076592878 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. Limits shown are as requested LTR TYPE OF INSURANCE INSO WVD POLICY NUMBER MMIDD/YYYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY MWZY EACH OCCURRENCE $2 , 000, 000 CLAIMS -MADE ❑X OCCUR DAMAGE TO RENI ED' PREMISES Ea occurrence S2,000,000 MED EXP (Any one person) $2 5 , 000 PERSONAL & ADV INJURY $2 , 000, 000 GEN'L AGGREGATE LIMITAPPLIES PER. GENERAL AGGREGATE $4,500,000 X POLICY ❑ JEo- �LOC PRODUCTS-COMP/OPAGG $4,000,000 OTHER' B AUTOMOBILE LIABILITY MWTB 313070-19 06/30/2019 06/30/2020 COMBINED SINGLE LIMIT Ea accident1 S5,000,000 BODILY INJURY ( Per person) X ANYAUTO BODILY INJURY (Per accident) OWNED SCHEDULED AUTOS ONLY AUTOS HIREDAUTOS NON -OWNED ONLY AUTOS ONLY PROPERTY DAMAGE Per accident C X UMBRELLA LIAB X OCCUR CSUSA1901330 06/30/2019 06/30/2020 EACH OCCURRENCE $2 , 000, 000 EXCESS LIAR CLAIMS -MADE AGGREGATE $2 , 000, 000 DED RETENTION A A` WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED' (Mandatory in NH) NIA WLRCS 7 475 All Other States SCFc50799487 WI Only 0 0 2 1 06/30/2019 06/30/2020 06/30/2020 X PER OTH- STATUTE FR E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE -EA EMPLOYEE $1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $1,000,000 A Excess WC wcucS0799499 06/30/2019 06/30/2020 EL Each Accident $1,000,000 WA Stop Gap Only EL Disease - Policy $1,000,000 SIR applies per policy ter s & conditions EL Disease - Ea Emp $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: City of Fort Colling Fleet Maintenance Shop, 835 wood St., Fort Collins, Co 80522, PO Number: 9146215, vendor Number: 541170. CERTIFICATE HOLDER 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 Colling Operations Services AUTHORIZED REPRESENTATIVE Attn: Nick ]ovene Bldg Laporte B Ave For Fort Collins CO 80521-2719 USA e..XXosa sLctiebtO na ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD