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HomeMy WebLinkAboutCHAMPION WINDOW CO OF FORT COLLINS LLC - INSURANCE CERTIFICATE (4)CHAMPIO-01 BFULKERSON . lk O CERTIFICATE OF LIABILITY INSURANCE �� FDATE 11/20/2015 Y) 1 v2onol s 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 Dayton/Assured Neace Lukens Insurance Agency, Inc. 8163 Old Yankee Street, Suite D Dayton, OH 45458 CONTACT Karen Mullins NAME: PHONE FAX lac No Exit: (937) 435-4788 AIc No): (937) 435-7395 ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: LM Insurance Corporation 33600 INSURED INSURERS: Ohio Casualty Insurance Co 24074 Champion Opco, LLC INSURER C : Sentry Insurance a Mutual Company 24988 Champion Window Co. of Ft. Collins, LLC 5850 Byrd Drive INSURER D : Loveland, CO 80538 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMRER- RFVISInN 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 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. ILTR I TYPE OF INSURANCE IINNSD WVD POLICY NUMBER MMIDDY EFF MM/DDY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE XOCCUR OH -WA -WY Stop Gap T65-Z91-461753-035 12/01/2015 12/01/2016 EACH OCCURRENCE $ 1,000,000 PREMISES Ea occurrence $ 300,000 X MED EXP (Any one person) $ 5,000 PERSONAL B ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY XPRO- JECT X LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS-COMP/OPAGG $ 2,000,000 'Stop Gap $ 1,000,000 A AUTOMOBILE LIABILITY ANY AUTO ALL OH AUTOSSCHEDULEDAUUTOSS HIRED AUTOSNON-OWNED AUTOS AS2-Z91-461753-015 12/01/2015 12/01/2016 COMBINED SINGLE LIMIT Ea accident)$ 1,000,000 X BODILY INJURY(Per person) $ BODILY INJURY(Per accident) $ PROPERTY DAMAGE Per accident $ B X UMBRELLA LIAR EXCESSLIAB X OCCUR CLAIMS -MADE USO(16)55279295 12/01/2015 12/01/2016 EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10,000,000 DED I X RETENTION $ 0 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICERIMEMBER EXCLUDED? ❑ (Mandatory in NH) e yes. describe under DESCRIPTION OF OPERATIONS below N I A I I 90-16232-01 12/01/2015 12/01/2016 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ - 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached K more apace Is required) nw�u�m City of Ft Collins PO Box 580 Fort Collins, CO 80522-0580 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AU'T/HHOR_IZ�E,D _REEPnRESEE�NTATIVE p ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD