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HomeMy WebLinkAboutS&B PORTA-BOWL RESTROOMS INC - INSURANCE CERTIFICATES&BPO-1 OP ID: SR , lli. R CERTIFICATE OF LIABILITY INSURANCE ATE (14/2015Y) P10 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 CRS Insurance Brokerage Risk Solutions DBA CONTACT Nathan M. Fonseca _ CNEl :303C„ FAXPHONE -996-7801 -757-7719Commercial 6600 E. Hampden Ave. Denver, CO 80224 E-MAIL ADDRESS: Nathan M. Fonseca INSURERS AFFORDING COVERAGE NAIC # INSURER A: Continental Western Ins Co. 10804 INSURED S&B Porta-Bowl Restrooms, Inc. INSURERS: Pinnacol Assurance 41190 3263 Oakland Street Aurora, CO 80010 INsuRERc: 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 MMlDD/YWY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS-MADE OCCUR CPA3004654 10/25/2015 10/25/2016 DAMA PREMISESS E ( RENTED Ea occurrence $ 100,00 MED EXP (Any one person) $ 6,00( PERSONAL & ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 POLICY FX-1 JEC LOC PRODUCTS - COMPlOP AGG $ 2,000,00 $ OTHER. AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,00 X BODILY INJURY (Per person) $ A ANY AUTO CPA3004654 10/25/2015 10/25/2016 ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Peraccitlent $ NON -OWNED HIRED AUTOS AUTOS $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,00 AGGREGATE $ 5,000,00 A EXCESS LIAB CLAIMS -MADE CPA3004654 10/25/2015 10/25/2016 DED X I RETENTION $ 0 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y ANY PROPRIETOR/PARTNER/EXECUTIVE � OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS beiow N/A 4062832 11/01/2015 11/01/2016 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,00 E.L DISEASE - EA EMPLOYEE $ 1,000,00 EL DISEASE � POLICY LIMIT $ 1,000,00 A Inland Marine ICPA3004654 10/25/2015 10/25/2016 Sched Equ 588,49 Ded $500 Lsd/Rntd 50,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) All policy terms, conditions and exclusions apply. CtK I IFICA I t HOLUtK CANCELLATION CITYFOR SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 580 Fort Collins, CO 80522 AUTHORIZED REPRESENTATIVE © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD