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HomeMy WebLinkAbout565996 BLACK EAGLE FENCE INC - INSURANCE CERTIFICATE (2)CERTIFICA BLACEAG-01 OF LIABILITY INSURANCE I DATE(Yk11DDIYYYY) crw rqn�n THIS CERTIFICATE IS ISSUED AS A MATTER OF CERTIFICATE DOES NOT AFFIRMATIVELY OR NE IATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS .Y AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BYTHEIPOLICIES ,CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WANED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer riahts to the Certificate holder in lieu of such endorsement(s) PRODUCER AssuredPartners dba Front Range Ins Group 2002 Caribou Drive, 9101 P.O. Box 270550 Fort Collins, CO 80525 INSURED Black Eagle Fence, Inc. PO Box 295 Loveland, CO 80539 envcoeracs CGRTICICATG NI IMQRP- RPVISIr1M NI IMRPR•. -_ , _ THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE, ILISTED 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 FOR THE POLICY PERIOD OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SU13JECT TO ALL THE TERMS, MAY HAVE BEEN REDUCED BY PAID. CLAIMS. INSR TYPE OF INSURANCE ADOL SUBR POLICY NUMBER -POLICY EFF POLICY EXPLTR IJYRS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE [X] OCCUR X Z67437 6/1/2020 6/1/2021 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Es occurrence)MED $ 100,000 EXP (Any oneperson) 5,000 PERSONAL &ADV INJURY $ 1'000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY ECpT LOC ❑ J OTHER: GENERAL AGGREGATE 2,000,000 PRODUCTS - COMP/OP. AGG $ 2,000,000 A AUTOMOBILE LUIBILITY ANY AUTO OWNEDSCHEDULEDAUT(% ONLY AUUpTNNO.OpSWW EEppBODILY ONLY X AUTOS ONLY X Z67437 6/1/202D 6/1/2021 COMBINED SINGLE LIMB (Ea accident)Ix $ 1,000,000 BODILY INJURY Per erson $ INJURY Per accidentAUTOS Perr accitl n AMAGE $ A UMBRELLA LIAB EXCESSLIAB X OCCUR CLAIMS -MADE Z67437 _ 6/1/2020 6/1/2021 EACH OCCURRENCE $ 2,000,000 X AGGREGATE $ 2,000,000 DED RETENTION $ B WORKERS COMPENSATION AND EYPLOYERSLIABILnY ANY PROPRIETORMARTNERIEXECUTIVE Y❑ OFFICEWMBER'.EXCLUDED? andatory in NH) If Y es, describe under DESCRIPTION OF OPERATIONS below NIA 148836 6/1/202D 6/1/2021 X PER OTH- E.L. EACH ACCIDENT 1,000,000 $ E.L. DISEASE -EA EMPLOYE 1 DDD ODD $. ' '. E.L. DISEASE - POLICY LIMIT 1,000,000 A Equipment Floater Z67437 6/1/2020 6/1/2021 Leased/Rented Equip 65,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional If required by written contract, signed by both parties prior to loss, General Liability: CB-7245(7-13) - Additional Insured - Completed Operations Automatic CB-7433(7-13) - Additional Insured - Owners, Lessees or Contractors CB-7252(12-19) - Waiver of Transfer of Rights of Recovery CB-1488 (07-13)- Primary and Noncontributory -Other Insurance SEE ATTACHED ACORD 101 Remarks Schedule, may be attached N more space Is required) the followingendorsements apply on a blanket bssis: Status Conditions SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Fort Collins THE EXPIRATION DATE THEREOF, _ NOTICE WILL BE DELIVERED IN tY ACCORDANCE WITH THE POLICY PROVISIONS. Director of Purchasing S Risk Management. PO Box 580 Fort Collins, CO 80522 AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AC®R®Y 11N� AGENCY CUSTOMER ID: BLACEAG-01 LOC #: 1 ADDITIONAL REMARKS SCHEDULE C3CTRUJILLO Page 1 of 1 AGENCY ssuredPartners dba Front Range Ins Group NAMED INSURED Bl Bc agi5 Fence, Inc. Loveland2,, CO 80539 POLICY NUMBER EE PAGE 1 CARRIER EE PAGE 1 NAIC CODE SEE P 1 EFFECTIVE DATE: SEEPAGE1 THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certincate of Liability Insurance Description of Operations/LocationsNehicles: Auto Liability: CA-7211(10-98) - Blanket Additional Insured CA-7247(10-16) - Waiver of Subrogation Workers Compensation: 359-B -Waiver oPSubrogation Excess Liability: Following Form over General Liability, Auto Liab and Employers Lability City of Fort Collins is named as additional insured if required by written contract © 2008 AC IRD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD