HomeMy WebLinkAboutBUILDER SERVICES GROUP INC DBA MATO - INSURANCE CERTIFICATE (3)A ® DAT (6/ 9/2020 0
CERTIFICATE F LIABILITY INSURANCE
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 INSURERA, AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: -If the certificate holder is an ADDITIONAL IN URED,,the poiicy(ies) must have ADDITIONAL INSURED provislons 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 to lieu of such endorsemerlt(s).
PRODUCER CONTACT
Aon Risk Services Central, Inc._PM
NAME: (666) 263-W2 FAx (800) 363-0105
Southfield MI office (w0•N°. Em): NC
3000 Town Center E-MAIL
suite 3000 ADDRESS:
Southfield MI 48075 USA
INSURER(S) AFFORDING COVERAGE NAIL N
INSURED INSURER A: oldd-Republic Insurance Company 24147
Builder Services Group, Inc. INSURERS: Old Republic General Ins Corp 24139
d/b/a Mato
A TopBuild Company INSURER6: Lloyd's syndicate No. 1969 AA1120106'
4275 Forest St INSURER D:
Denver CO 80216 USA
INSURER F:
❑�nnn000�Oo� -
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN
BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FORTHEPOLICY PERIOD
OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENTWITH RESPECT TO WHICH THIS
AFFORDED BY THE POLICIES -DESCRIBED HEREIN ISSUBJECTTO ALL THE TERMS,
MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits shown are as requested
LTR
TYPE OF INSURANCE
FNSD
VVVD
POLICY NUMBER
MWDD
MMVD
- __ LamS
X
COMMERCUILGENERAL LIABILITY
CLAIMS -MADE ❑X OCCUR
MWN
-
-.
EACH OCCURRENCE
$2,000,000
DAMAGE To Hr=N1 LU
PREMISES Eaoccurreoce
$2,000,000
MED EXP (Any one person)
$25 , 000
PERSONAL &ADV INJURY
$2,000,000
GENLAGGREGATE LIMIT APPLIES PER:
PO-
X POLICY EJECTEl LOC
OTHER:
GENERAL AGGREGATE
$4,000,000
PRODUCTS - COMP/OP AGG
$4,000,000
A
AUrOMOa1LE LIABILITY
X ANYAUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
HIRED AUTOS NON�WNED
ONLY AUTOS ONLY
MwTB 313070-20
06/30/2020
06/30/2021
COMBINED SINGLE LIMIT
fEa accident
$5,000,000
BODILY INJURY (Per person)
BODILY INJURY (Per acciderd)
PROPERTY DAMAGE
Per accident
C
X
UMBRELLALIAB
EXCESS LIAB
X
OCCUR
CLAIMS -MADE
_
CSUSAZU
L5.1U
06/30/ 02
06/30/2021
EACH OCCURRENCE
$2,000,003
AGGREGATE
$2,000,000
DIED RETENTION
A
B
WORKERS_ COMPENSATION AND-
EMPLOYERTLABILITY YIN
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICERIMEMBEREXCLUDED7
(Mandatory In NM
If yyes, describe under
DESCRIFTIONOF OPERATIONS below
N/A
MWC3155
All Other
2Mwc31557520
OR Only
12
States
0 30 02
06/30/2020
6 3 2021
06/30/2021
X
PER STATUTE
1
OTTH-
ER
E.L. EACH ACCIDENT
$1,000,000
E.L. DISEASE -EA EMPLOYEE
$1,000,000
E.L. DISEASE -POLICY
$1,000, 000
A
Excess WC
w7S31557220
wA stop Gap only
06/30/2020
06/30/2021
EL Each Accident
EL Disease - Policy
EL Disease - Ea Emp'
$1,000,000
$1,000,000
$1,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, rosy be attached I more spice Iarequlred)
RED: 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 30vene "
Bldg B
360 Laporte Ave
Fort Collins Co 80521-2719 USA
IbtleeL�1� �►
m1988-2015 ACORD CORPORATION. Alf rights reserved.
ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD