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HomeMy WebLinkAboutINLET STRUCTURES INC - INSURANCE CERTIFICATE (6)OP ID: SS ,a►ka R CERTIFICATE OF LIABILITY INSURANCE FDATE 05/28/2015Y) 05/28/2015 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 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 endorsements . PRODUCER Phone: 720-962-0930 NAMEACT Shaleen Martin Six & Geving Insurance Inc #4 Fax: 720-962-0942 Denver Branch 225 Union Blvd. #575 Lakewood, CO 80228 Nancy McGrath PHONE 303-653-0023 FAX No : 720-962-0942 IC, No Edt : _ E-M ess: smartin@six-geving.com PRODUCER INLET-1 CUSTOMER ID III: INSURERS AFFORDING COVERAGE NAIC # INSURED Inlet Structures Inc. INSURER A:Employers Mutual Casualty 21415 Danny 8r Rachel Garza INSURER B : Pinnacol Assurance 41190 5110 York Street Denver, CO 80216 INsuRERc: INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 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. INSR LTR TYPE OF INSURANCE ADDL'SUB POLICY NUMBER POLICY EFF MM/DD POLICY EXP MM/DD/YYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE _x1 OCCUR X 3D23855 06/02/2015 06/02/2016 EACH OCCURRENCE $ 1,000,00 100,00 DAMA r�ED PREMISES Ea occurrence)$ MED EXP (Any one person) $ 5,00 PERSONAL & ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PRO LOC PRODUCTS - COMP/OP AGG $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS 3E23855 06/02/2015 06/02/2016 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,00 X BODILY INJURY (Per person) $ $ BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) $ $ A UMBRELLA LIAR EXCESS LIAB iX OCCUR CLAIMS -MADE 3J23855 06/02/2015 06/0212016 EACH OCCURRENCE $ 5,000,00 AGGREGATE $ 5,000,00 DEDUCTIBLE RETENTION $ 10,000 $ $ X _ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y I❑NN OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A 4018512 CO ONLY 04/01/2015 04/01/2016 X I WC STATU- OTH- E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYEE $ 1,000,00 E.L. DISEASE - POLICY LIMIT 1 $ 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) City of Fort Collins is named as additional insured as respects General Liability if required by written contract. CTYFT-1 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. AUTHORIZED REPRESENTATIVE AJZ��� © 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD