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Home My WebLink AboutBLM CONSTRUCTION - INSURANCE CERTIFICATEBLMCOA OP ID: SDN CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 06/18/2015 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 PFS Insurance Group - JT 4848 Thompson Pkwy, Ste 200 Johnstown, CO 80534 Johnstown Select Accounts CONTACT NAME: PHONE FAX A/c No Ext : A/C No): ADDRIESS: INSURERS AFFORDING COVERAGE NAIC # INSURER A: Colorado Casualty Insurance Co 41785 INSURED Blm Construction INSURER B : .. INSURER C : John Davison 829 Peterson St Fort Collins, CO 80524-3320 INSURER D : INSURER E : ..._ INSURER F : ......r= ^=0 f`C07I1=I1-ATF NUMBER: REVISION NUMBER: �.Uvr=rwv�� 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. ILTR TYPE OF INSURANCE AD L UB POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 PREMISES Ea occurrence $ 300,00 A X COMMERCIAL GENERAL LIABILITY BKS55733734 12/13/2014 12/13/2015 MED EXP (Any one person) $ 15,00 CLAIMS -MADE � OCCUR PERSONAL & ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,00 $ POLICY . PRO LOC COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY Ea accident BODILY INJURY (Per person) $ NA ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS OOWNED PROPERTY DAMAGENON- PER ACCIDENT $ HIRED AUTOS AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE NA DED RETENTION $ OTH- STATU-$ WCY WORKERS COMPENSATION I R LIMIT, E.L. EACH ACCIDENT $ AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE NA E.L. DISEASE _EA EMPLOYEE $ OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) N / A E.L. DISEASE -POLICY LIMIT $ If yes, describe under DESCRIPTION OF OPERATIONS below NA NA DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) carpentry interior CITYFC1 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 P.O. BOX 580 AUTHORIZED REPRESENTATIVE Fort Collins, CO 80522 l9 Ty00-Au I Al.Urcv INURrvr\I1r rUIN. nn nynw Icac,.c. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD