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HomeMy WebLinkAbout490634 DOUGLAS B HOLT & TUBA USTUNER - INSURANCE CERTIFICATE (6)�.--� DOUGBHO-01 JCARROLL ACt7R0 �„_,� 4/(MM'DD(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE DATE 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 endorsement(s). PRODUCER CONTANAME: CT Select Business Division GIA Group, LLC PHONE (970) 384-8334 FAX No : (970) 945-6027 1605 Grand Avenue A/c No Ext Suite K E•MAIL Glenwood Springs, CO 81601 ADDRESS: SBD@glenwoodins.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A; Central Insurance Companies INSURED INSURER B : Douglas B. Holt & Tuba INSURER C : Ustuner 2945 JUllliard St. INSURER D : Boulder, CO 80305-7035 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 DL INSD BR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X I COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR Al X CLP 9755791 04/03/2016 04/03/2017 EACH OCCURRENCE $ 1,000,000 PREMISES Ea occurrence $ 300,000 ME EXP (Anyone person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ❑PRO- ❑ JECT LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS -COMP/OP AGG $ 2,000,000 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ A :>. UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE CXS 9755792 04/03/2016 04/03/2017 EACH OCCURRENCE $ 1,000,00 :. AGGREGATE $ DED I X I RETENTION$ 10,000 1,000,000 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ElN/A (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT 1 $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate holder is named as additional insured. RE:221-227 Jefferson, Fort Collins, CO CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Fort Collins Utilities THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 117 N Mason St. Fort Collins, CO 80524 AUTHORIZED REPRESENTATIVE © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD