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HomeMy WebLinkAboutINLET STRUCTURES INC - INSURANCE CERTIFICATE (7)OP ID: SS CERTIFICATE OF LIABILITY INSURANCE DATE 05/2IY 04/5/2016 6 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 endorsements . PRODUCER Phone: 720-962-0930 NAME: CONTACT Shaleen Martin Six & Geving Insurance Inc #4 PHONE FAX Denver Branch Fax: 720-962-0942 JA/lC. No, Ext): 303-653-0023 (Arc, No): 720-962-0942 225 Union Blvd. #575 ADDRESS: smarten@six-geving.COm Lakewood, CO 80228 PRODUCER INLET-1 Nancy McGrath CUSTOMER ID #: INSURERS AFFORDING COVERAGE NAIC # INSURED Inlet Structures Inc. INSURERA: Employers Mutual Casualty 21415 Danny& Rachel Garza INSURER B: Pinnacol Assurance 41190 5110 York Street Denver, CO 80216 INSURERC: INSURER D : INSURER E INSURER F : i_�7VFRA[�FS t^_FRTIFICATF NIIMRFR• RFVISION 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. INSR LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MMLDD YYYY MM/DDYYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 1XI OCCUR X 3D23855 06/02/2015 06/02/2016 EACH OCCURRENCE $ 1,000,00 DAMAGE TO RENTED 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: POLICY X PRO LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS 3E23855 06102/2015 COMBINED SINGLE LIMIT (Ea accident) 06/02/2016 BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) $ 1,000,000 X $ $ $ $ $ A UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE 3J23855 06/02/2015 EACH OCCURRENCE AGGREGATE 06/02/2016 ----- $ 5,000,000 $ 5,000,000 --- $ DEDUCTIBLE RETENTION $ 10,000 X B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YINN OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below / A 4018512 CO ONLY 04/01/2016 04/01/2017 WC STATU- OH - X TORY LIMITS ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) City of Fort Collins is named as additional insured as respects General Liability if required by written contract. CERTIFICATF H01 nFR CANCFI I ATION CTYFT-1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Fort Collins THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. P.O. Box 580 Fort Collins, CO 80522 AUTHORIZED REPRESENTATIVE © 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD