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HomeMy WebLinkAboutBLACK TIMBER BUILDERS LLC - INSURANCE CERTIFICATE (3)i9 ACORO CERTIFICATE OF LIABILITY INSURANCE 1`� DATE(MMIDD/YYYY) 7/16/2019 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 Madison Insurance Group 600 South Cherry St. Ste 900 Denver CO 80246 NAME: Paula Blohm ac No Ext: 3033220800 FAX AIC, No: 3033220874 ADDRESS: pblohm@madisoninsurance.net INSURER(S) AFFORDING COVERAGE NAIC p INSURER A: PINNACOL ASSURANCE 41190 INSURED Black Timber Builders, LLC 641 Whedbee Street Fort Collins CO 80524 INSURER B : CLEAR BLUE SPECIALTY INSURANCE CO INSURER C : INSURERD: INSURER E : INSURER F : Cr1VFRAr:FR CFRTIFICATF NtIMRFR: 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 MND POLICY NUMBER (MM/DDNYYY) MMIDDNYYY LIMITS B X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR 103 GLOO14825-02 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 I JE � LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON-0NMED AUTOS ONLY AUTOS ONLY (Ea accident)$ BODILY INJURY (Per person) $ BODILY INJURY (Per accitleM) $ (Per accident) $ UMBRELLA LIAB EXCESS LIAB CLAIMS -MADE EACH OCCURRENCE $ HOCCUR AGGREGATE $ DED RETENTION$ $ - A WORKERS COMPENSATIONIR AND EMPLOYERS' LIABILITY ANY FFICER/MEM ER EXCLUDED ECUTIVE Y❑N Mandatory in NH) If yes, describe under ESCRIPTION OF OPERATIONS below NIA 4190143 03/01/2019 03/01/2020 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 101, Additional Remarks Schedule, may be attached if more space is required) The City of Fort Collins P.O. Box 580 Fort Collins, CO 80522 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Swaw�4 Ja�fay ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD