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HomeMy WebLinkAboutCUSTOM AIR INC - INSURANCE CERTIFICATE (4)Client#: 33379 CUSAIRPC ACORD,, CERTIFICATE OF LIABILITY INSURANCE DATE IDD/YYYY) /29/2015 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 CONTACT Laura Leovic NAME: Holmes Murphy -Colorado ��"�" o El):720-622-8243 (A/C, No): 855-534-8896 7600 East Orchard Rd, Ste 330 South E-MAIL lleovicC)holmesmurphy.com Greenwood Villaae. CO 80111 INSURED Custom Air, Inc. 3930 South Decatur Street Englewood, CO 80110 INSURERS) AFFORDING COVERAGE I NAIC # INSURER A: Continental Western Insurance C 110804 INSURER B : Pinnacol Assurance Company 141190 INSURER D : INSURER E : COVERAGES CERTIFICATE NIIMRFR- RFVISION NIIMRFR- 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 CONTRACTOR 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 TYPE OF INSURANCE ADD L SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YY A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F_XI OCCUR X PD Ded: $500 CPA3109547 10/01/2015 10/01/2016 EACH OCCURRENCE $1 000000 PREMISES Ea occurrence $300, 000 MED EXP (Any one person) $10 000 PERSONAL & ADV INJURY $1,000,000 $2,000,000 $2,000,000 GENERAL AGGREGATE GEN'L AGGREGATELIMIT APPLIES PER: POLICY X PRO-- LOC PRODUCTS - COMP/OP AGG $ A A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS X NON -OWNED AUTOS CPA3109547 0/01 /2015 10/01 /201 COBINED S INGLE LIMIT Ea Maccident 1,000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ X PROPERTY DAMAGE Per acc dent $ X UMBRELLA UAB EXCESS LIAB X OCCUR CLAIMS -MADE CPA3109547 0/01 /2015 0/01 /2015 10/01/2016 10/01/2016 EACH OCCURRENCE s6.000.000 AGGREGATE s6,000,000 DED I X RETENTION $O X TWO STATUO'Y- OTH- $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A 4061749 E.L. EACH ACCIDENT $1 00O 000 E.L. DISEASE - EA EMPLOYEE $1 000 0,00 E.L. DISEASE - POLICY LIMIT $1 000 000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more space is required) L,th I II -ILA I t rIULUt:H (;ANUtLLA I IUN City of Fort Collins P.O. Box 580 Fort Collins, CO 80522 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 (2010/05) 1 of 1 #S159333/M159321 64a7 -& ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD MANV1