Loading...
HomeMy WebLinkAbout133159 PAUL DAVIS RESTORATION OF NORTHERN COLORADO - INSURANCE CERTIFICATE (4)LEGAC-4 OP ID: SF ,4coRO" CERTIFICATE OF LIABILITY INSURANCE r ATE(MM/DD/YYYY) 06/24/2015 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 CONTANAME: Jeramie Holt PFS Insurance Group - JT PHONE FAX 4848 Thompson Pkwy, Ste 200 A/c No Ext:970-635-9400 I (A/C, No):_970-635-9401 Johnstown, CO 80534 E-MAIL ADDRESS: Jeramie Holt INSURERS AFFORDING COVERAGE NAIC # INSURER A: Allied Insurance Group 19100 INSURED Legacy Corporation INSURER B : Everest Indemnity Ins. Company Paul Davis Restoration of INSURER C: Pinnacol Assurance Co 41190 Northern Colorado 309 Lincoln Court INSURERD: Fort Collins, CO 80524 INSURER E INSURER F rnvFRA(:FS CFRTIFICATF NIIMRFR• REVISION NIIMRER: 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 INSD SUB WV POLICY NUMBER MMIDD YYYYPOLICY ICY EXP MMLDD YYYY LIMITS B X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS -MADE Fx] OCCUR EF4ML05315141 07/01/2015 07/01/2016 DAMAGE TO RENTED PREMISES Ea occurrence $ 50,00 X i MED EXP (Any one person) $ 5,00 Blkt Al X Blkt WOS PERSONAL & ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,00 POLICY JE� LOC PRODUCTS - COMP/OP AGG $ 3,000,00 Pollution $ 3,000,00 OTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,00 BODILY INJURY (Per person) $ A X ANY AUTO ACP3006672462 07/01/2015 07/01/2016 ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY nt DAMAGE Per accide $ NON -OWNED X HIRED AUTOS X AUTO X Blkt Al X Blkt WOS $ X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 2,000,00 AGGREGATE $ 2,000,00 B EXCESS LIAR CLAIMS -MADE EF4C000657141 07/01/2015 07/01/2016 DED I X I RETENTION $ 10,000 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN 4156670 07/01/2015 07/01/2016 PER OTH- X STATUTE X I ER E.L. EACH ACCIDENT $ 1,000,00 OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) N/A E.L. DISEASE - EA EMPLOYEE $ 1,000,00 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1 000,00 , A Property ACP3006672462 07/01/2015 07/01/2016 BPP 70,00 A Equipment Floater ACP3006672462 07/01/2015 07/01/2016 Leased/Re 100,00 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) If required by written agreement, the certificate holder is included as additional insured for ongoing operations under general liability. L;ANI:tLLA I IUN CITYFC1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS. P.O. Box 580 Fort Collins, CO 80522 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD