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HomeMy WebLinkAboutBUILDER SERVICES GROUP INC DBA MATO - INSURANCE CERTIFICATE (5)A`CORO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 06/04/2016 I 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 AOn Risk Services central, Inc. Southfield MI Office CONTACT NAME: (A/CC..NNo. Ext): (866) 283-7122 jaC No.): (800) 363-0105 E-MAIL ADDRESS: 3000 Town Center Suite 3000 Southfield MI 48075 USA INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A: Old Republic Insurance Company 24147 Builder Services Group, Inc. INSURER B: AIG Europe Limited AA1120841 d/b/a Mato A TopBuild Company INSURERC: ACE American Insurance Company 22667 INSURER D: ACE Fire Underwriters Insurance Co. 20702 4850 Lima Street Denver CO 80239 USA INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570057923998 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. Limits shown are as requested LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMlDD/YYYY MM10D/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY MWZY304634 1 EACH OCCURRENCE -DTMAGE t2,000,000 CLAIMS -MADE X❑ OCCUR TO RENTED PREMISES Ea occurrence)$2 , 000 , 000 MED EXP (Any one person) $2 5 , 000 PERSONAL B ADV INJURY $2,000,000 GEML AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE PI., 000, 000 X POLICY ❑ PRO-❑ LOC JECT PRODUCTS - COMP/OP AGG $4,000,000 OTHER: A AUTOMOBILE LIABILITY MWTB 304835 06/30/2015 06/30/2016 COMBINED SINGLE LIMIT Ea accident $5 , 000 , 000 BODILY INJURY ( Per person) ANY AUTO BODILY INJURY (Per accident) ALL OWNED SCHEDULED AUTOS AUTOS IXX HIRED AUTOS X NON -OWNED AUTOS PROPERTY DAMAGE (Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE AGGREGATE EXCESS LIAB CLAIMS -MADE DED RETENTION C D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR / PARTNER I EXECUTIVE OFFICER/MEMBEREXCLUDED" (Mandatory in NH) N/A WLRC48151553 All other States SCFC4815190 WI Only 06/30/2015 06/30/2015 06/30/2016 06/30/2016 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $1 , 000 , 000 E-L. DISEASE -EA EMPLOYEE $1 , 000 , 000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DI.SEASF-POLICY LIMIT $1, 000 , 0nn DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) [Prof: RE: Project Name: Police Department]. co rn rn N rn 0 0 O Z d QU w Q 0) U CERTIFICATE HOLDER CANCELLATION f� 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 Colling Operations Services AUTHORIZED REPRESENTATIVE �V Attn: Nick lovene - 300 Laporte Ave., Building B Fort Collins CO 80521 USA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD 1 ® A��RO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 06/04/2015 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 endorsement(s). PRODUCER Aon Risk Services Central, Inc. Southfield MI Office CONTACT NAME: (A/C..NNo. Ext): (866) 283-7122 sac No ): (800) 363-0105 E-MAIL ADDRESS: 3000 Town Center Suite 3000 Southfield MI 48075 USA INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A: Old Republic Insurance Company 24147 Builder Services Group, Inc. d/b/a Mato A TOpBuild Company INSURER B: AIG Europe Limited AA1120841 INSURERC: ACE American Insurance Company 22667 INSURER D: ACE Fire underwriters Insurance Co. 20702 4850 Lima Street Denver Co 80239 USA INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570057924011 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 Limits shown are as requested LTR TYPE OF INSURANCE INSD SUBRI WVD POLICY NUMBER MM/OD/YYYY MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY mwzy3046J4 15 06/30/2717 EACH OCCURRENCE $2 , 000 , 000 CLAIMS -MADE X❑ OCCUR AMA ENTED PREMISES Ea occurrence $2 000 000 MED EXP (Any one person) $25 , 000 PERSONAL &ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4 , 000 , 000 X POLICY ❑ JECT PRO - PRODUCTS - COMP/OP AGG $4,000,000 OTHER: OTHER: A AUTOMOBILE LIABILITY MWTB 304835 06/30/2015 06/30/2016 COMBINED SINGLE LIMIT (Ea accident $5 000 000 BODILY INJURY ( Per person) X ANY AUTO BODILY INJURY (Per accident) ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS X NON -OWNED AUTOS .1 PROPERTY DAMAGE Per accident) UMBRELLA LIAB EACH OCCURRENCE AGGREGATE EXCESS LIAB HOCCUR CLAIMS -MADE DED I RETENTION C D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR / PARTNER, EXECUTIVE OFF ICER/MEMBEREXCLUDED? N (Mandatory in NH) N/A WLRC48151553 All Other States SCFC4815190 WI Only 06/30/2015 06/30/2015 06/30/2016 06/30/2016 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $1 , 000 , 000 E.L. DISEASE -EA EMPLOYEE $1, 000, 000 If yes, describe under DESCRIrTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT S1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: City of Fort C011ing Fleet Maintenance Shop, 835 Wood St., Fort Collins, CO 80522, PO Number: 9146215, Vendor Number: 541170. 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 Lolling Operations Services AUTHORIZED REPRESENTATIVE Attn: Nick 7ovene 300 Laporte Fort Collins Ave., Building B CO 80521 USA 0 m d w m d a 0 2 0 V N 0 0 Pik NN ib A 1;7M, f.A ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD