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HomeMy WebLinkAboutBUILDER SERVICES GROUP INC DBA MATO - INSURANCE CERTIFICATE (6)ACORL7 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) oa/o7/zols 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 have ADDITIONAL INSURED provisions or 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 Aon Risk Services Central, Inc. Southfield MI office CONTACT NAME: PHONE (866) 283-7122 F0X (800) 363-0105 (A/C. No. Ext): (A C. No.): E-MAIL ADDRESS: 3000 Town Center Suite 3000 INSURER(S) AFFORDING COVERAGE NAIC # Southfield MI 48075 USA INSURED INSURER A: Old Republic Insurance Company 24147 Builder Services Grouo. Inc. INSURER B: ACE American insurance Company 22667 d/b/a Mato A TopBuild Company INSURERC: ACE Fire Underwriters Insurance Co. 20702 INSURER D: 4850 Lima street Denver Co 80239 USA INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570061744108 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. Limits shown are as requested INSR LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MM DD LIMITS A X COMMERCIAL GENERAL LIABILITY MWZY304834 EACH OCCURRENCE 12,000,000 CLAIMS -MADE "OCCUR DAMAGE T RENTED PREMISES Ea occurrence $ 2 , 000 , 000 MED EXP (Any one person) $25 , 000 PERSONAL &ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4 , 000 , 000 X POLICY ❑ PRO ElLOC JECT PRODUCTS - COMP/OP AGG $4,000,000 OTHER: A AUTOMOBILE LIABILITY MWTB 304835 06/30/2015 06/30/2016 COMBINED SINGLE LIMIT Ea accident 15,000,000 BODILY INJURY ( Per person) X ANY AUTO BODILY INJURY (Per accident) OWNED SCHEDULED AUTOS ONLY AUTOS X HIRED AUTOS X NON -OWNED ONLY AUTOS ONLY PROPERTY DAMAGE Per accident UMBRELLA LIAB EACH OCCURRENCE AGGREGATE EXCESS LIAB HOCCUR CLAIMS -MADE DED RETENTION B C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/ PARTNER/ EXECUTIVE 0 FICER/MEMBEREXCLUDED? (Mandatory in NH) NIA WLRC48151553 All other States SCFC48151590 WI Only 06/30/2015 06/30/2015 06/30/2016 06/30/2016 X STATUTE ERH E.L. EACH ACCIDENT $1OOO000 , , E.L. DISEASE -EA EMPLOYEE $1, 000, 000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $1 , 000 , 000 1 -1 .......... 7 1 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Project Name: South Transit Center Lobby. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City Of Fort Collins AUTHORIZED REPRESENTATIVE 300 Laporte Ave., Building B Fort Collins CO 80521 USA 00 0 v v 0 0 IrLO O Z d ft5 O d L) ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD