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HomeMy WebLinkAboutTEAMMATES COMMERCIAL INTERIORS INC - INSURANCE CERTIFICATE (2)TEAMM-1 OP ID: CLM ,aco�zn° CERTIFICATE OF LIABILITY INSURANCEF09/28/2015 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). CRS Insurance Brokerage Commercial Risk Solutions DBA 6600 E. Hampden Ave. Denver, CO 80224 Scott M. White, CIC, ARM CONTAPRODUCER NAME: Scott M. White, CIC, ARM PHONE FAX Arc No Ezt : 303-996-7801 tAIC,No): 303-757-7719 ADDRIESS: INSURERS AFFORDING COVERAGE NAIC 0 INSURER A: Westfield Insurance 24112 INSURED Teammates Commercial Interiors INSURER B: Pinnacol Assurance 41190 320 S Teller Street, Suite 250 Lakewood, CO 80226-3237 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 LTR TYPE OF INSURANCE ADDL UB POLICY NUMBER POLICY EFF 1 POLICY EXP MM/DD/YYYY MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS -MADE � OCCUR X CWP3177709 10/01/2015 10/01/2016 DAMA E( RENTED PREMISESSEa occurrence $ 500,00 MED EXP (Any one person) $ 5,00 PERSONAL &ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,00 POLICY JERCOT LOC PRODUCTS - COMP/OP AGG $ 2,000,00 $ OTHER. AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea ac cident $ 1,000,00 BODILY INJURY (Per person) $ A X ANY AUTO X CWP3177709 10/01/2015 10/01/2016 BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS X X NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Per accident $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,00 AGGREGATE $ 51000,00 A EXCESS LIAB CLAIMS -MADE CWP3177709 10/01/2015 10/01/2016 DED X RETENTION $ 0 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY IN ANY PROPRIETOR/PARTNER/EXECUTIVE Y� OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N / A 4062360 10/01/2015 10/01/2016 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 500,00 E.L. DISEASE - EA EMPLOYEE $ 500,00 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT 5OO OO $ , DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: 8026 Furniture for New Utilities Administration Building. The City of Fort Collins, its officers, agents and employees are included as additional insured for ongoing operations on the General Liability and included as additional insured on the Auto Liability with respect to operations of the named insured for the certificate holder as required by written City of Fort Collins Financial Services Purchasing Devision P.O. Box 580 Fort Collins, CO 80522 CITYFTC 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 ACORD 25 (2014/01) ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD HOLDER CODE CITYFTC TEAMM-1 PAGE 2 NOTEPAD. INSURED'S NAME Teammates Commercial Interiors OP ID: CLM Date 09/28/2015 tract. All policy terms, conditions and exclusions apply.