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HomeMy WebLinkAboutADVANCED MANUFACTURING TECHNOLOGY FOR BOTTLES INC - INSURANCE CERTIFICATEOP ID: SC CERTIFICATE OF LIABILITY INSURANCE DATE 07107120/ YY) o7ro7i2o1 s 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 Phone:970-223-1804 Front Range Insurance Group 1100 Haxton Drive Suite 100 Fax: Fort Collins, CO 80525 David A. Wooldridge LUTCFAAI CONTACT NAME: PHONE FAX C No Ext : A/C No): E-MAIL ADDRESS: PRODUCER ADVAN01 CUSTOMER ID 11 INSURERS AFFORDING COVERAGE NAIC11 INSURED Advanced Manufacturing Technology for Bottles, Inc. RLT Land, LLC 3920 Patton Avenue Loveland, CO 80538 INSURER A: Travelers 28188 INSURER B: Pinnacol Assurance 41190 INSURERC: INSURERD: 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. IPOLICY LTR TYPE OF INSURANCE POLICY NUMBER MMIUDY EXP MMIDDIYYYY LIMITS A A A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR X EPLI+Fiduciary 630-72881-698 105516762 PL-14T43473 11/01/2014 11/01/2014 11/01/2014 11/01/2015 11/01/2015 11/01/2015 EACH OCCURRENCE $ 1,000,00 AMA' PREMISES Ea occurrence $ 100,00 MED EXP (Any one person) $ 5,00 PERSONAL & ADV INJURY $ 1,000,00 X Manuf E&O (PL) GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER X POLICY FROT LOC PRODUCTS- COMPIOP AGG $ 2,000,00 E&O (PL) $ 2,000,00 A A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS Hired Auto Phy Dmg BA-7288L698 BA-7288L698 BA-72881_698 BA-72881_698 11/01/2014 11/01/2014 11/01/2014 11/01/2014 11/01/2015 11/01/2015 11/01/2015 11/01/2015 COMBINED SINGLE LIMIT $ 1,000,00 X BODILY B BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE rPeraccident) $ X X HAPhyDing $ 150,00 X Coll/Comp Deduc $ $250 Eac B X UMBRELLA UAB EXCESS LIAB X OCCUR CLAIMS -MADE LIP-1 1 T4082A-1 4-NF 11/01/2014 11/01/2015 EACH OCCURRENCE $ 5,000,00 AGGREGATE $ 5,000,00 DEDUCTIBLE RETENTION $ 10,000 $ X $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICERIMEMBER EXCLUDED? ❑N (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N I A 3489992 06/01/2015 06/01/2016 X WC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ 1,000,00 E.L DISEASE -EA EMPLOYEE $ 1,000,00 E L DISEASE - POLICY LIMIT $ 1,000,00 A A Leased/Rented Equi Property 630-72881-698 630-72881-698 11/01/2014 11/01/2014 11/01/2015 11/01/2015 L&R Equip 75,00 2 Locatio 2,997,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) CITYOFF City of Fort Collins Parks Division 413WBryan Ave Fort Collins, CO 80521 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 © 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD