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Home My WebLink About541354 COATING SPECIALISTS LLC - INSURANCE CERTIFICATE (4)orzo� CERTIFICATE OF LIABILITY INSURANCE DATE IMMIDD/YYYY) 06/27/2017 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 have ADDITIONAL INSURED provisions or 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 L.L)NIA NAME: Pinnacol Assurance PHONE 7501 E Lowry Blvd ac�r Denver. CO 80230-7006 .1 old INSURER A: INSURED _ INSURER B Coating Specialist LLC-.-..._._-._ 6340 Sayres Road INSURER c ............................ Colorado Springs, CO 80927 INSuRERD: Pinnacol Assurance COVERAGES CERTIFICATE NUMBER: RFVISION NIIMRFR- 41190 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 ............ ADDU SUER POLICY EFP ...POLICY EXP LTR TYPE OF INSURANCE INSO WVD POLICY NUMBER MMtDD/YYYY) (MWDDfYYYYJ, LIMITS COMMERCIAL GENERAL LIABILITY _ EACH OCCURRENCE $ CLAI;315 MADE .:OCCUR _ . _ DAMAGE TO RENTED... __� E PREMiSSCEa ogcurren el _. �$ II $ _ MED EXP (Any one person) 1 $ u _ PERSONAL 8 ADV INJURY GEML AGGREGATE LIMIT APPLIES PER -„- GENERAL AGGREGATE Is PROPOLICYLOC _...... PRODUC_TS - COMP/0 P GG$ .......... ... ...... . - . i1 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) ............ __._ ' .......___........... ............._._..._......_ ANY AUTO I BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) ,S HIRED NON -OWNED PROPERTY DAMAGE - $ AUTOS ONLY AUTOS ONLY (Per accidentL UMBRELLA LIAB OCCUR r EACHOCCURRENGE ....... ..... $ ........ ---------- ---_........ .. EXCESS LIAB CLAtMS-MADE —.. _ AGGREGATE .........._...__.__....... _.._....-...... ---------- DED RETENTION 5 $ WORKERS COMPENSATION X PER O i H STATUTE AND EMPLbYERS' LIABILITY YIN ER ANYPROPRiETOf2/PARTNERtEXECUTIVE ! A OFFICER,MEMB'-REXCLUE Ya N / A' 4124367 07/01 /2017 07/01 /2018_ _ E.L. :EACH ACCIDENT $ 1,000,000 (Mandatory in NH) E.L.; DISEASE - EA EMPLOYEE $ 1,000,000 11 yes. describe antler- - DESCRIPTION OF OPERATIONS below E.L. DISEASE - POUdY LIMIT' i $ 1,000,000 j I DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Unless otherwise stated in the policy provisions, coverage is in Colorado only. Refer to the Acord 101 Additional Remarks Schedule for supplemental cancellation notification information. Excluded (If any) : Frank Vigil, Dora Vigil CERTIFICATE HOLDER CANCELLATION 1810308 City of Fort Collins - Director of Purchasing and Risk Managment PO Box 580" Fort Collins, CO 80552 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 Western Group, Inc - Colorado Sprin C 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD CERTIFICATE HOLDER COPY IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the poiicy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage affordedby the policies listed thereon. DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT (CONT) AGENCY CUSTOMER ID: LOC #: N/A N/A �-1 ACORO�� ADDITIONAL REMARKS SCHEDULE Page 4 of 5 AGENCY Western Group, Inc - Colorado Sprin NAMEDINSURED Coating Specialist LLC 6340 Sayres Road Colorado Springs, CO 80927 POLICY NUMBER 4124367 CARRIER Pinnacol Assurance NAIC CODE 411901 EFFECTIVE DATE: 06/27/2017 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: Acord 25 (2016'0�ORM TITLE: Certificate of Liability Insurance SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO NOTIFY 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO NOTIFY SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. ACORD 101 (2008101) C 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD