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HomeMy WebLinkAboutMPB CONTRACTORS INC - INSURANCE CERTIFICATE (2)®DATE(MMIDDIYYYY) A`C> o CERTIFICATE OF LIABILITY INSURANCE 6i26/_2020. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION O-NUT 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 REPRESENTATIVEOR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must 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 NAME: Olson & Olson Ltd PHONE FA 5655 S. Yosemite St. #200 303-867-2061 A c No :363-867-2074 Greenwood Village CO 80111 ADDRESS: certificates olsonandolson.com MPBCOA DB Contractors, Inc. 55 Chambers Road rora CO 80011 41190 I INSURER C: Continental Casualtv Comoanv 1 20443 1 _ . CAVFRAf:FS CERTIFICATF NIIMRFR- 1RR901AR7R REVISION Nl1MBER- 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. INSR LTR TYPE OF INSURANCE I L BR POLICY NUMBER lImn3 YEFF !POLMMID EXPI LIMITS B X _.__.. _ C'OMMERCULL GENERAL LIABILITY CPA322546+f-21 7/12020 7/10021 EACH OCCURRENCE $1,000;000 CLAIMS -MADE rx] OCCUR PREMISES Ea omunence $ 500,0M MED EXP (Any one person) $ 5,000 PERSONAL 8 ADV INJURY $ 1,000.000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE S2,000.000 POLICY Ea LOC PRODUCTS - COMP/OP AGG $2.000,000 $ OTHER: B AUTOMOBILE LIABILITY CPA3225464-21 7/112020 V12021 COMBINED SINGLE LIMIT Ea accident $ 1000000 BODILY INJURY (Per person) $ x ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PRO amid nDAMAGE E NOWOWNX HIRED AUTOSX AUTOSEO $ B UMBRELLA LIAB X OCCUR CPA32254 21 7/112020 7/1r2021 EACH OCCURRENCE $ 5,000,D00 AGGREGATE $ 5,000,000 EXCESS LIMB CLAIMS -MADE _ DIED RETENTION $. _. Prod Com s A . $ 5,000,000 . A WORKERS COMPENSATION AND EMPLOYERS'LUI8IU1Y YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? El NIA 405MM 7/12020 7/12021 X STATUTE ERH E.L EACH ACCIDENT - $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 (Mandatory In NMI It yes, describe under DESCRIPTION OF OPERATIONS below — - — E.L.DISEASE - POLICY_LIMIT. - ---- $ 1,000,000 C C Installation Floater Leased/Rented Eq. 6078811864 6078811854 7M/2020 7/l/2020 7/12021 7/12021 Jobsite/Ded:$1.600 $2,600.000 LimiVDed. $1,000 $150,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, AddBbrul Remerke tchedule, may be attiched N more spaci Is required) CONTRACTUAL LIABILITY APPLIES PER POLICY TERMS AND CONDITIONS A WRAP EXCLUSION APPLIES PER POLICY TERMS AND CONDITIONS Other Coverages: See Attached... 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 Collins P.,O. Box 580 AUTHORIZED REPRESENTATIVE Fort Collins CO 80522-0580 a�ttt�! ©1988-2014 ACORD CORPORATION. All rights reserve ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD ACORU® L I AGENCY CUSTOMER ID: MPBCO-1 LOC �: ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY Olson & Olson Ltd I NAMED INSURED MPB Contractors, Inc. 3155 Chambers Road Aurora CO 80611 POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, enolu ul luoco• 25 onam TITI I:• CERTIFICATE OF LIABILITY INSURANCE 04 92 10.18 Form Attached Includes: Additional Insured — Ongoing Operations status when re Waiver of Subrogation applies when required by written 2062.09.16 Form Attached Includes: Additional Insured — Completed Operations status when 01 14 09.16 Form Attached Includes: Primary & Non -Contributory status to Additional insured LIABILITY: 20 93 03.19 Form Attached Includes: t Additional Insured status applies when required i Waiver of Subrogation applies when required by t Primary & Non-Conhibutorystatuslo Additional RS COMPENSATION — Colorado 113 Pinnacol (CO) Form Attached Includes: Waiver of Subrogation applies when required by LLA LIABILITY 3 Liability policy is on a follow form basis for the' ective Date: 07-01-20 to 07-01-21 7ireman's Insurance Company of Washington D.C. (� Personal Property Limits: 1 — 3155 Chambers Rd, Aurora CO 80011: $50,000 e: $1,000 2 —11150 Huron St, Northglerm CO 80234: $25,060 e: $1,000 policy forms referenced will be sent via email only. To ractor's License. The ACORD written contract. required by written contract. applies when required by a written contract. contract. by a written contract. underlying insurance coverages: General Liability; Automobile Liability and Employers Liability. copies, please send your request with the email address to certificates@olsonandolson.com © 2008 A, and logo are registered marks of ACORD rights reserved.