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HomeMy WebLinkAboutETHOS GENERAL CONTRACTORS DBA ETHOS ROOFING AND RE - INSURANCE CERTIFICATEETHOGEN-01 KSTEFANSKI FDATE (MM/DD/YYYY) ,a►coRo CERTIFICATE OF LIABILITY INSURANCE 312912016 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). rnuTnr.T PRODUCER MHIA, LLC 4704 Harlan St., Unit 360 Denver, CO 80212 PHONE ��,.13031237-5445 I (FAX, AIC No): (303) 239-8807 NAIC # tINSRER : Mesa Underwriters Specialty Insurance Company (Music) INSURED :Owners Insurance Company 32700 Ethos GeneralContractors :FIRST MERCURY INS. CO.dba Ethos Roofing and Restoration : Pinnacol Assurance41190 10303 E Dry Creek Road Ste 400 Englewood, CO 80112 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: _.._ - ..^%A1 UAVC acGkl Iccl IFn TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD THIS INDICATED. CERTIFICATE EXCLUSIONS INSR LTR IS TO CERTIFY THAT THE POLICIES NOTWITHSTANDING ANY REQUIREMENT, MAY BE ISSUED OR MAY AND CONDITIONS OF SUCH POLICIES. TYPE OF INSURANCE OF PERTAIN, L IN D INSUHANGE LIMITS WVD LIJ ICV DG--„r .�"��• TERM OR CONDITION OF ANY THE INSURANCE AFFORDED BY SHOWN MAY HAVE BEEN REDUCED POLICY NUMBER MP0005003000474 - ----IHlb CONTRACT THE POLICIES BY PAID POLICY EFF MMIDD 03/29/2016 OR OTHER DESCRIBED CLAIMS. POLICY EXP MM/DD/YYYY 03/29/2017 DOCUMENT WITH RESPECT HEREIN IS SUBJECT TO LIMITS EACH OCCURRENCE ALL THE TERMS, $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FX-1 OCCUR PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ 5.000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000'000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO - JECT LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ B OTHER: AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOSNON-OWNED HIRED AUTOS AUTOS 4937261100 01/09/2016 01/09/2017 COMBINED SINGLE LIMIT Es accident $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ $ C UMBRELLA LIAB X OCCUR X EXCESS LIAB CLAIMS -MADE 1247711 03I28/2016 03/28/2017 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below D N / A 4174536 02/01/2016 02101/2017 X PER STATUTE 0 H E.L. EACH ACCIDENT 1 000,000 $ _� E.L. DISEASE - EA EMPLOYEE $ i,000,000 E.L. DISEASE - POLICY LIMIT 1 000 000 $ , > DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) r A L11101 1 A T1f11J CERTIFICATE HOLDER City of Fort Collins PO Box 580 Fort Collins, CO 80526 a,.nnv� 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 ACORD 25 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD