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HomeMy WebLinkAbout521758 SUMMIT SEALANTS INC - INSURANCE CERTIFICATE (2)ACORa 16- CERTIFICATE OF LIABILITY INSURANCEF5/29/2015 DATE (MMIDDfYYYY) 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 endorsement(s). PRODUCER Colorado BW Insurance Agency, Inc. 1211 North 7th Street PO BOX 4088 Grand Junction CO 81502 CONTACT Leandra Ludlam NAME: A(CNNo Ext: (970)243-9012 FANo: (970)241-8175 EMAILAbDREss.leandra.ludlam@bankofthewest.com INSURERS AFFORDING COVERAGE NAIC f INSURER A:Berkley Re 1 Specialty Ins Co INSURED Summit Sealants, Inc. 13671 Carefree Drive Montrose CO 81403 INSURER B :Nationwide Mutual Ins. Company 3787 INSURERC:St Paul Fire & Marine 24767 INSURERD:Plnnacol Assurance 41190 INSURER E :American Risk Management INSURERF: COVERAGES CERTIFICATE NUMBER:15/16 Yune Renewal 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 SUBR POLICY NUMBER POLICY EFF MMIDDIYYW POLICY EXP MMIDDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 7TMAGE TO RENTED PREMISES Ea occurrence $ 100,000 X COMMERCIAL GENERAL LIABILITY A CLAIMS -MADE a OCCUR X GL0036925-26 6/1/2015 6/1/2016 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 X Primary X NOR -Contributory GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS - COMP/OP AGG $ 2,000,000 PL2009570-11 Pollution /23/2014 /23/2015 $ X POLICY X PRO X LOC (carrier E) AUTOMOBILE LIABILITY Ea accident INGLE LIMIT 1,000,000 BODILY INJURY (Per person) $ B ANY AUTO ALL OWNED SCHEDULED X AUTOS AUTOS X CP7545193302 6/1/2015 6/1/2016 BODILY INJURY (Per accident)$ PROa(perPERdTneY tDAMAGE $ X HIREDAUTOS N AUTNOOVrtJED X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10,000,000 C EXCESS LIAB CLAIMS -MADE ZUP13TO4762 14DED I X I RETENTION$ 10,000 $ Policy is following form 6/1/2015 /1/2016 D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERIEXECUTIVE � OFFICER/MEMBER EXCLUDED? (Mandatory In NH) NIA 0�5879 6/1/2015 /1 /2016 X WC STATU- OT E.L. EACH ACCIDENT $ 1 000,000 c` c c EL DISEASE-_AEMPLCYE e 1,000,000 E L. DISEASE -POLICY LIMIT 1 $ 1,000,000 IAs, describe under CRIPTION OF OPERATIONS below B Inland Marine, Special kCP7545193302 6/1/2015 /1/2016 Installation $20,000 Form $1,000 Deductible Rented/LeasedEquip $150,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) Project: Civic Center Parking Garage City of Fort Collins is named as Additional Insured as required per written contract 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 W Laport Building B AUTHORIZED REPRESENTATIVE Fort Collins, CO 80521 Leandra Ludlam/GRJLL ACORD 25 (2010105) INS025 (201005).01 © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACORN® CERTIFICATE OF LIABILITY INSURANCEF5/29/D29/ lDDIY2015YYY) 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 endorsement(s). PRODUCER Colorado BW Insurance Agency, Inc. 1211 North 7th Street PO BOX 4088 Grand Junction CO 81502 CONTACT Leandro Ludlam NAME: FAX PAHIONEo Ext: (970)243-9012 AIC No: (970)241-3175 E-DRESS MAIL leandra.ludlam@bankofthewest.com INSURERS AFFORDING COVERAGE NAIC INSURER A:Berkle Re 1 Specialty Ins Co INSURED Surfunit Sealants, Inc. 13671 Carefree Drive Montrose CO 81403 INSURERB:Nationwide Mutual Ins. Company 3787 INSURERC:St Paul Fire & Marine 24767 INSURERD:Plnnacol Assurance 41190 INSURER E:Ameri can Risk Management INSURER F: COVERAGES CERTIFICATE NUMBER:i5/io June Renewal 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 MMIDDIYYYY MMIDD YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 11000,000 COMMERCIAL GENERAL LIABILITY DA AGE To 'X PREMISES Ea occurrence $ 100,000 A CLAIMS -MADE a OCCUR X GL0036925-26 6/1/2015 6/1/2016 MED EXP (Any one person) $ 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 X Primary X Non -Contributory GENERAL AGGREGATE $ 2,000,000 PL2009570-11 Pollution /23/2014 /23/2015 GEN'LAGGREGATE LIMIT APPLIES PER : PRODUCTS - COMP/OPAGG $ 2,000,000 $ X POLICY X PRO- X LOC (carrier E) AUTOMOBILE LIABILITY COMBINED 7177�� Ea accident 1,000,000 BODILY INJURY (Per person) $ B ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS N AAUUTNOONMED X kCP7545193302 6/1/2015 6/1/2016 X X BODILY INJURY (Per accident) $ (perraccdent AMAGE $ X UMBRELLA LAB X OCCUR EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10,000,000 C EXCESS LIAB CLAIMS -MADE ZUP13TO4762 DED I X I RETENTION$ 10,000 $ Policy is following form 6/1/2015 6/1/2016 D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE � OFFICER/MEMBER EXCLUDED? (Mandatory in NH) A NIA 0�5879 6/1/2015 /1/2016 X WC STATU- OTH- TORY IM T E.L. EACH ACCIDENT $ 1 000,000 CISEASF-FAFMPI_nYF. $ 1,000 000 [E'- E L DISEASE - POLICY LIMIT $ 1,000,000 f yes, describe under DESCRIPTION OF OPERATIONS below B Inland Marine, Special CP7545193302 6/1/2015 6/1/2016 Installation $20, 000 Form $1,000 Deductible Rented/LeasedEquip $150,000 DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Project: 7674 Parking Garages Repairs & Waterproofing The City of Fort Collins is named as Additional Insured for the General and Liability as required by written contract. UhK IIhIGAI t HULI LAIVLtLLAIIUN City of Fort Collins 215 N Mason St 2nd Floor 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 Ludlam/GRJLL ACORD 25 (2010/05) INS0251 �otuo5}o1 © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD