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HomeMy WebLinkAboutMICHAEL NOELLER CONTRACTING LLC - INSURANCE CERTIFICATE (5)DATE (MM/DD/YYYY) ACCOR" "® CERTIFICATE OF LIABILITY INSURANCE F11/3/2015 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 Janice Aaron NAME: The Reilly Company LLC PHONE Ext): (913)682-1234 FAX Not (913)682-8136 608 Delaware St. ADDRESS:Janice.aaron@reillyinsurance.com P.O. Box 9 INSU S) AFFORDING COVERAGE NAIL N Leavenworth KS 66048-0009 INSURERAAllied Group 00035 --- ------- INSURED INSURER 8 : Michael Noeller Contracting, LLC INSURERC: 20017 NE 116TH St INSURER E : f Liberty MO 64069 I INSURERF: COVERAGES CFRTIFICATF NIIMRFR-Master 15 corrected RFVISION NIIMRFR- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELO` .' 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. INTR TYPE OF INSURANCE SUBR POLICY NUMBER MM/ DIYYYYJ (MMIDDNYYYI LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE ❑X OCCUR DAMA E TO RENTED PREMISES LEa occurrence) $ 300,000 $ 15,000 ACP 3007352616 10/31/2015 10/31/2016 MEDEX_P(Any one person) $ 1,000,000 PERSONAL 8 ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE POLICY X 1 JECT LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER. AUTOMOBILE LIABILITY COMBINED SINGLEDIMWIT— (Ea accident) $ 1,000,000 X ANY AUTO BODILY INJURY (Per person) $ A ALL OSCHEDULED AUUTOSS AUTOS ACP BAA 3007352616 10/31/2015 10/31/2016 BODILY INJURY (Per accident) $ X X NON -OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS __LPe_r_accident) Underinsured motorist $ 1,000,000 X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS -MADE AGGREGATE $ 1,000,000 DED X RETENTION$ 10,000 ACP CAA 3007352616 10/31/2015 10/31/2016 $ WORKERS COMPENSATION y PER OTH- AND EMPLOYERS' LIABILITY Y / N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? N / A -- - A (MandatoryinNH) ACP WC 3007352616 10/31/2015 10/31/2016 E.L. DISEASE - EA EMPLOYEE $ 500,000 it yes, oescnbe unaer - ----_---- -- - DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 A Leased/Rented Equipment ACP 3007352616 10/31/2015 10/31/2016 Limit $75,000 ded $1,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) GtK I IFIGA I t HULUtK GANGtLLAI IUN (970)224-6134 ktharp@fcgov.com City of Fort Collins PO Box 580 Fort Collins, CO 80522-0580 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 James Bray/JANICE © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD INS025 (201 a01)