HomeMy WebLinkAboutMICHAEL BOTTOMS BUILDER LLC - INSURANCE CERTIFICATE—�1 MICHBOT-01 VMATHIASON
A`CORO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
12/17/2015
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 CONTACT
NAME:
PFS Insurance Group PHONE ------ FAX
4848 Thompson Parkway Suite 200 (A/C, No, Ell: (970) 635-9400 (/X,No :-.- 970 635-9401
Johnstown, CO 80534 E;MAILcc. infniAmvnfainamtrnnrn nnm
INSURED
Michael Bottoms Builder LLC
Michael Bottoms DBA
3202 Sparrow Hawk Lane
Berthoud, CO 80513
COVERAGFS r.1=PTIrIr`ATr- Ail IRAC2=6.
INSURER(S) AFFORDING COVERAGE
INSURER A: United Fire & Casualty Group
INSURER B :
INSURER C
INSURER D :
INSURER E :
INSURER F :
NAIC #
13021
wmuu�.
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 ADDL SUBR ... -
TYPE OF INSURANCE POLICY EFF POLICY EXP
INSD WVD POLICY NUMBER MM/DD/YY MM/DD/YYYY ', LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
CLAIMS -MADE N OCCUR
X
60411268 01/24/2016
01/24/2017
-DAMAGE
NTEO_PREMISnce)
100,000
ESO(Ea
$
MED EXP (Any one person)
$ 5,000
PERSONAL & ADV INJURY
$ 1,000,000
_--_
GEN'L
AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 2,000,00
POLICY PRO
I JECT LOC
_-J u
----
PRODUCTS - COMP/OP AGG
- ---- — -
— —
$ 2,000,000
OTHER:
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
$
(Eaaccident) _._ _--- --.--ANY
AUTO
BODILY INJURY (Per person)
$
ALL OWNED SCHEDULED
AUTOS AUTOS
BODILY INJURY (Per accident)
$
NON -OWNED
HIRED AUTOS AUTOS
PROPERTY DAMAGE
$
(Per accident)
UMBRELLA LIAB OCCUR
EACH OCCURRENCE
$
AGGREGATE_ _ _ _
$
EXCESS LAB CLAIMS -MADE
DED RETENTION $
$
WORKERS COMPENSATION
P R TH-
AND EMPLOYERS' LIABILITY Y/ N
STATUTE ER
E.L. EACH ACCIDENT
$
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? ❑
N/A
(Mandatory in NH)
if yes, describe under
E.L. DISEASE - EA EMPLOYE
$
E.L. DISEASE - POLICY LIMIT
$
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required)
Carpentry
Carpentry/All Locations/All OperationslWhere required by written contract or agreement, Certificate holder is included as additional insured under General
Liability coverage with respect to ongoing operations.
CERTIFICATE HOLDER r-enlr rl I ATlnnl
City of Fort Collins
215 North Mason Street
Fort Collins, CO 80524
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZE
/j9 REPRE►S'E,N%TATIVE
V &, �/ 46
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