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HomeMy WebLinkAboutBLACK TIMBER BUILDERS LLC - INSURANCE CERTIFICATE (2)acoROJ CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD YYYYI 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 NAME: Paula Blohm Madison Insurance Group FAX AHoNN, Ext , 3033220800 (A/C, No): 3033220874 ADDRESS: pblohm(amadisoninsurance.net 600 South Chang St. Ste 900 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : PINNACOL ASSLTLANCE 41 190 Denver CO 80246 INSURED INSURER B : CLEAR BLUE SPECIALTY INSURANCE- CO INSURER C Black Timber Builders, LLC INSURER D : 641 Whedbee Street INSURER E : INSURER F : Fort Collins CO 80524 COVERAGES CERTIFICATE NUMBER: 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 LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM1DD/YYYY) (MMIDDIYYYYI LIMITS B X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FXI OCCUR AROI-RS-1900593-00 07/12/2019 07/12/2020 EACH OCCURRENCE $ 1,000.000 PREMISES(Ea occurrence) $ 100.000 MED EXP (Any one person) $ 5,000 PERSONAL& ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER POLICY FRIPRO JECT ❑ LOC OTHER GENERAL AGGREGATE $ 2,000.000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ AUTOMOBILE LIABILITY ANY AUTO D SCHEDULED OWNES AUTOS AUTOONLY HIRED NON -OWNED AUTOS ONLY AUTOS ONLY (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ (Per accident) $ UMBRELLA LAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y I N FFICERIMEMBER EXCLUDED ❑ Mandatory in NH) If yes describe under DESCRIPTION OF OPERATIONS t ilow NIA 4190143 03/01/2019 03/01/2020 y ) STATUTE ER E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYEE $ 100.000 E L DISEASE - POLICY LIMIT $ 500.000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD tot, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN The City of Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE P.O. Box 580 pa,,el.a, 1310 F w Fort Collins. CO 80522 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD