HomeMy WebLinkAboutFRAMEWORKS TIMBER - INSURANCE CERTIFICATE (4)Jul. 15,
r '111
2015 3:17PM
No.4839 P.
, ,.o4u,E-1
1 OP ID: JL
ACC7Ra- CERTIFICATE OF LIABILITY INSURANCE
P0711612015
07/1612Q15
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(les) 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 endorsements .
PRODUCER
Woolington Agency, LLC
2823 Central Ave
Cheyenne, WY 82001
Will de Ryk
CONTACT
NAM .Will de R k
PHONE FAX
307-772.3333 307-634-3814
ADDRE88: wili@wyoagency.com
INSURERS AFFORDING COVERAGE
NAIC
INSURER A: Vlnin s Insurance Company
INSURED Frameworks Timber
INSURER 8 t Pinnacol Assurance
208 Racquette Dr., Unit 8
Fort Collins, CO 80524
INSURER0:
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.
ILTR
TYPE OF INSURANCE
ADDL
POLICY NUMBER
MWOD�Y
MWO��Y
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
cLAIMs•MAOE 0 occuR
X
PKG016143700
06114/2016
06/14/2016
EACH OCCURRENCE
$ 1,000,00
PREMISE EaONmENDnce1
E 100.00
MED EXP (Any oneperson)
a 5100
PERSONAL SADVINJURY
$ 1,O00,00
GEN'L AGGREGATE LIMIT APPLIES PER
X POLICY a jE&j ❑ LOc
OTHER
GENERAL AGGREGATE
$ 2,000,00
PRODUCTS - COMPIOP AGG
$ 2,000,00
$
AUTOMOBILE
LIABILITY
ANYAUTO
AUTO �RD SAUTOSULED
HIRED AUTOS NON -OWNED
AUTOS
COMBINED SINGLE LIMIT
(Es noodent)
$
BOOILYINJURY(Per person)
$
80DILYINJURY (Per ecadent)
f
PROPERTY DAMAGE
Per de
$
$
UMBRELLA LIAO
EXCESS LIAR
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
$
AGGREGATE
$
DEO I I RETENTION
$
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETORlPARTNERIEXECUTNE YIN
OFFICER/MEMBER EXCLUDED? ❑
(Mandatory in NH)
H DEes, desalbe under
SCRIPTION OF OPERATIONS below
NIA
12148T
03/01/2015
03101/2016
PER ORTH-
E.L. EACH ACCIDENT
$ 600,00
E.L. DISEASE - EA EMPLOYEE
$ 500,00
E.L. DISEASE - POLICY I IMIT
6 500,00
DESCRIPTION OF OPERATIONS! LOCATIONS I VEHICLES (ACORD 101, Additional Relnark6 8che4We, may be attached If more space Is raqulred)
REF: City of Ft. Collins is an Additional Insured under the Blanket
Additional Insured Endorsement.
City of Ft. Collins
Attn; John Stevens
281 N. College
Ft. Collins, CO 80624
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
�i �_ �L
01888-2014 ACORD CORPORATION. All rights reserved.
ACORD 26 (2014101) The ACORD name and logo are re8istered marks of ACORD