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HomeMy WebLinkAbout344336 LIND'S PLUMBING & HEATING INC - INSURANCE CERTIFICATE (3)CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 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 CONTACT NAME: PHONE FAX (A/C, No, Ext): (A/C, No): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : INSURED INSURER B : INSURER C : INSURER D : 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. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES (Ea occurrence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- LOC PRODUCTS - COMP/OP AGG $ JECT OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY STATUTE ER Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N / A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN NOTEPAD INSURED'S NAME Date PAGE LINDS-2 2 Lind's Plumbing & Heating Inc. OP ID: H2 07/27/2015 If required by written contract, the following endorsements apply: General CGD246 08/Liability: 05 - Blanket Additional Insured (Contractors) Including wording ongoing and completed operations and primary/non-contributory CGD316 11/11 - Blanket Waiver of Subrogation Auto CAT353 Liability: 03/10 - Business Auto Extension Form Includes Blanket Additional Insured and Waiver of Subrogation Workers 359B - Blanket Compensation: Waiver of Subrogation Pollution: G-with 130922C-a written Blanket contract Additional in place, Insured prior (Client) to the and pollution waiver of incident, subrogation that specifically required them to be listed as an additional insured. ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD Tyler B. Allen LINDS-2 OP ID: H2 07/27/2015 Jody Wagner Brown & Brown Inc 4532 Boardwalk Dr, Suite 200 Fort Collins, CO 80525 Tyler B. Allen 970-482-7747 970-484-4165 jwagner@bbcolorado.com Pinnacol Assurance Company 41190 Lind's Plumbing & Heating Inc. Travelers Indemnity Company 25658 1414 Blue Spruce Drive #A Fort Collins, CO 80524 Travelers Property Casualty Co 25674 The Phoenix Insurance Co 25623 Columbia Casualty Company 31127 D X 1,000,000 X X DTCO4775N321PHX15 05/10/2015 05/10/2016 300,000 X Contractual 5,000 1,000,000 2,000,000 X 2,000,000 1,000,000 B X X DT8104775N321IND15 05/10/2015 05/10/2016 X X 4.000,000 C DTSMCUP4775N321TIL15 05/10/2015 05/10/2016 4,000,000 X 10,000 X A 4042794 05/01/2015 05/01/2016 1,000,000 N 1,000,000 1,000,000 E Pollution Liab CEO6018467746 06/04/2015 06/04/2016 Occurrenc 1,000,000 Claims Made $5,000 SIR Aggregate 2,000,000 The City of Fort Collisn is included as additional insured per forms and conditons on pg 2. CITYOFF City of Ft. Collins PO Box 580 Fort Collins, CO 80522