HomeMy WebLinkAboutWILMARK ENTERPRISES INC - INSURANCE CERTIFICATEACOR I g
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
06/28/2019
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 Karen Tibbetts
NAME:
Moody Insurance Agency, Inc.
PAH/CONN Ext : (303) 824-6600 FAAX No): (303) 370-0118
8055 East Tufts Avenue
E-MAIL karen.tibbetts@moodyins.com
ADDRESS:
INSURER(S) AFFORDING COVERAGE
NAIC #
Suite 1000
INSURER A: Cincinnati Insurance Companies
2000
Denver CO 80237
INSURED
INSURER B : Plnnacol Assurance
41190
INSURER C :
W Ilmark Enterprises Inc
INSURER D :
P O BOX 120
INSURER E :
INSURER F
Firestone CO 80520-0120
COVERAGES CERTIFICATE NUMBER: 19-20 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAYBE 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.
ILTR
TYPE OF INSURANCE
INSD
WVD
POLICY NUMBER
MM/DDY/YYYY
MM/DD/YYYY
LIMITS
X
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
CLAIMS -MADE � OCCUR
DAMAGE TO RENTED
PREM SES (E. occu"."ce
$ 500.000
MED EXP (Any one person)
$ 10,000
PERSONAL & ADV INJURY
$ 1,000,000
A
Y
ENP0444642
07/01/2019
07/01/2020
GEN'LAGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 2,000,000
PRO -
X POLICY PRO LOC
PRODUCTS - COMP/OPAGG
$ 2,000,000
Employee Benefit Liability
$ 1,000,000
OTHER:
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
Ea accident
$ 1,000,000
X
BODILY INJURY (Per person)
$
ANYAUTO
A
OWNED SCHEDULED
AUTOS ONLY AUTOS
ENP0444642
07/01/2019
07/01/2020
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
Per accident
$
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
Medical payments
$ 5,000
X
UMBRELLA LIAB
X
OCCUR
EACH OCCURRENCE
$ 1,000,000
AGGREGATE
$ 1,000,000
A
EXCESS LIAB
CLAIMS -MADE
ENP0444642
07/01/2019
07/01/2020
DED I X RETENTION $ 10,000
$
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY y / N
ANY PRO PRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? FYINIA
(Mandatory in NH)
4059734
07/01/2019
07/01/2020
X1 PER STATUTE EORH-
E.L.EACHACCIDENT
$ 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
$
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
f,tKI II-It..AI t MULUtK 1,.ANL r-LLAI IUN
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.
300 LaPorte Ave
AUTHORIZED REPRESENTATIVE
Fort Collins CO 80521.--�-
@ 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD