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HomeMy WebLinkAbout398103 B & W GLASS INC - INSURANCE CERTIFICATE (3)B&WGLAS-01 TTREVILLYAN A4.7 ORL7 �. CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 10/13/2015 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 Burns Insurance Agency, Inc PO Box 250 Burns, WY 82053 CONTACT NAME: _ PHONE FAX o Ext : (307 ) 547-3571 A/C No): (307) 547-3573 A/c No, ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: The Cincinnati Insurance Company INSURED INSURER B : INSURERC: B&W Glass, Inc. Tom Ludtke 2200 East 15th St. INSURER D : Cheyenne, WY 82001 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 INSD WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE [X] OCCUR X X CPP 1084110 10/14/2015 10/14/2016 DAMAGE TO RENTED -- PREMISES Ea occurrence $ 50,000 MED EXP (Any one person) $ 5,000 J PERSONAL 8 ADV INJURY $ 1,000;000 AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 IGEN'L POLICY T PRO- JECT LOC PRODUCTS - COMP/OP AGG $ 2,000,000 STOP GAP $ 1,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ A X ANY AUTO X X CPP 1084110 10/14/2015 10/14/2016 ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ NON -OWNED HIRED AUTOS AUTOS _ $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 AGGREGATE $ A EXCESS LAB CLAIMS -MADE X X CPP 1084110 10/14/2015 10/14/2016 DED I X I RETENTION $ 10,000 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YI'� OFFICER/MEMBER EXCLUDED) �f (Mandatory in NH) NIA X CPP1084110 10/14/2115 10/14/2016 PER OTH- STATUTE I X I ER E.L.EACH ACCIDENT $ 1,000,000 E L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E L DISEASE - POLICY LIMIT $ 1,000,000 A rented/leased equip CPP 1084110 10/14/2015 10/14/2016 rented/leased 60,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more space is required) CERTIFICATE HOLDER CANCELLATION CITY OF FORT COLLINS AMBER DENOOY PO 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 © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD