HomeMy WebLinkAboutMARTIN FIRE PROTECTION INC - INSURANCE CERTIFICATE (2)AC®R& CERTIFICATE OF LIABILITY INSURANCE
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DATE MM00nYYr>
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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 isan ADDITIONAL INSURED, the policy(ies) ,musthave ADDITIONAL INSURED provisions, or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and Conditions of the policy, certain poll icies.may require an endorsement. A statement on
this certificate does not Confer rights to:the certificate holder, In,ifeu of a ch;endorsement s ..
PRODUCER
GKS Insurance Agency:
8044 W. Highway 50, #201
Salida CO 81201
CONTACT
NAME: Diahann.L. GIoiT10
PHone A
• 719-539-0144 A/c N :.719-539 4696
E-MAIL ... ..:_ _.:...:
ADDRESS: dgibrrfd@cfsd6nver.com
INSURER AFFORDING COVERAGE
NAICC
INSURER A: Westfield Insurance
24112
INSURED MARTI-S
Martin Fire Protection, Inca
12295 Pennsylvania Street, #461
Thornton. CO 80241
... . _..
-.
.INSURER B : Plnnacol Assurance -
41190
iNsuRERc: Hudson Specialty Insurance Co.
37079
INSURER D:
'INSURER E :
INSURER F:
COVERAGES CERTIFICATE NUMBER: 91133n3131 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
IND)CATED. NOTWITHSTANDING ANY REOUIREMENT, 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.
TYPEOF INSURANCE
AODL
UBR
WVD.
POUCYNUMBER
POUCY EFF
MIND /YY
POLICY EXP
M10
UMITS
C
X COMMERCIAL GENERAL LIABILITY
FS_1.000473-W
4/1/2020
4/1/2021
EACHOCCURRENCE
$1.000,000,
i CL:AIMS•MADE. [:8� OCCUR
PREMISEOE-S fEaoocurrance
$100,000
MED EXP An one person).
$ 5,000
X E&O Coverage Em
PERSONAL & ADV INJURY
$1,bo0;00D
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE'
$2,000,000
POLICY I jE?T LOC
PRODUCTS - COMP/OPAGG
$2,060,600
$
OTHER:
A
AUTOMoBILEUABtLRY
CWP1096222
4/1/2020
4/1/2021
-
COMBINED SINGLE LIMIT
(Ea aoadeqi
S1:D00,000
BODILY INJURY .(Pee Person)
$
X ANY AUTO _
OWNED SCHEDULED
AUTOS ONLY AUTOS
BODILY INJURY (Per acadenq
S
PROPERTYDPMAGE,
Per accident
$,
X. HIRED x NON -OWNED
-- - AUTOSONLY AUTOS ONLY
$
_
C
X
UMBRELLAUAB I X
OGCUR
FSL0000225-01
411/2020
4/1/2621
EACH OCCURRENCE
$2.000,000
AGGREGATE.
$
EXCESS UAB
CLAIMS -MADE
. DED. X :RETENTION$.inrnnn.
.. .. ._.....
I S _ .... _......_..
.,. .. _.
_.
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANYPROPRIETORIPARTNER/DCECUTIVE YIN
4149255
4/1/2020
411/2021
x STATUTE `ER
E.L. EACH ACCIDENT
$.1,000,000
OFFICER(MEMBEREXCLUDED?
N/A
(Mandatory In NH)
E.L. DISEASE - EA EMPLOYEE
$1;000,000
.-
Ilyyes, describe under
DESCRIPTION.OF OPERATIONSC.below
__ _ _ __
E.L. DISEASE.- POLICY.LIMIT
$1 000,000
A
Inland Marine
CWP1096222
4/1/2020
4/1/2021
50.000
500 Deductible
Leased&Rented Equip
....
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule; may, be attached if more space Is required)
All policy terms, conditions and exclusions apply.
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 Collins
300. LaPorte Avenue
AUTHORIZED REPRESENTATIVE
Fort Collins CO 80521
01988=2015 ACORD CORPORATION. All rights reserved..
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
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