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ADVANCED MANUFACTURING TECHNOLOGY FOR BOTTLES INC - INSURANCE CERTIFICATE (2)
OP ID: TA ACORO• CERTIFICATE OF LIABILITY INSURANCE D 11/02//2 V015 11/025 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 Phone: 970-223-1804 Fron1100tRange Insurance Haxton Drive Suite Group00 Fax: Fort Collins, CO 80525 David A. Wooldridge LUTCFAAI CONTACT ac PHONE Ext : FAX No): E-MAIL ADDRESS: PRODUCCUSTOMER ID MADVAN011 INSURERS AFFORDING COVERAGE NAIC p INSURED Advanced Manufacturing Technology for Bottles, Inc. RLT Land, LLC 3920 Patton Avenue Loveland, CO 80538 INSURER A: Travelers 28188 INSURER B; Pinnacol Assurance 41190 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 I B POLICY NUMBER POLICY YYY MMIDDIYE POLICYFF EXP D MM D LIMITS A A A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE O OCCUR X EPLI+Fiduciary 630-72881_698 105516762 ZPL-14T43473 11/01/2015 11/01/2015 11/01/2015 11/01/2016 11101/2016 11/01/2016 EACH OCCURRENCE S 1,000,00 PREMISES Ea occurrence S 100,00 MED EXP (Any one person) $ 5,00 PERSONAL & ADV INJURY $ 1,000,00 X ManufE&O(PL) GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO LOC PRODUCTS - COMP/OP AGG $ 2,000,00 E&O (PL) $ 2,000,00 A A A A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIREDAUTOS NON-OWNEDAUTOS HiredAuto Phy Omg BA-7288L698 BA-728BL698 BA-72881_698 BA-72881_698 11/01/2015 11/0112015 11/01/2015 11/01/2015 11/01/2016 11/01/2016 11/0112016 11/01/2016 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,00 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ X X HAPhyDmg $ 150,00 X CollIComp Deduc $ $250 EaC B X UMBRELLALIAB EXCESS LIAB X OCCUR CLAIMS -MADE ZUP-11T40e2A 1110112015 1110112016 EACH OCCURRENCE $ 3,000,00 AGGREGATE $ 3,000,00 DEDUCTIBLE RETENTION $ 10,000 $ X $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE � OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA 3489992 06/01/2015 06/01/2016 X WC STATdU OTH- T RY LIMITS ER E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYE $ 1,000,00 E.L. DISEASE - POLICY LIMIT I $ 1,000,00 A A Leased/Rented Equi Property 630-72881_698 630-728BL698 11/0112015 11/01/2015 11/0112016 11/01/2016 L&R Equip 75,00 2 Locatio 2,997,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) CITYOFF City of Fort Collins Parks Division 413 W Bryan Ave Fort Collins, CO 80521 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 ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD