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HomeMy WebLinkAboutMPB CONTRACTORS INC - INSURANCE CERTIFICATE (4)M/D D/YYYY) (M A�ORO® CERTIFICATE OF LIABILITY INSURANCE 6/DATE DATE(M 7 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 PRODUCER NAME:V Jlson & Olson Ltd PHONE 303-867-2061 Fax 303-867-2074 5655 S. Yosemite St. #200 (A/C No. Ertl: (A[C. No): E-MAIL o2@olsonandolson.com 3reenwood Village CO 80111 AnDREss: INSURERA:Westfield Insurance Company 24112 INSURED MPBCO-1 INSURERS:PInnacol Assurance 41190 MPB Contractors, Inc. INSURERC: 3155 Chambers Road Aurora CO 80011 INSURERD: INSURER E : rnvcnAr_cc !`CDrlrlf`Arc 6n I11/IRCD• 7995597'AR 0F1/ICIf11U !UI IRARFR- 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 INSO WVD POLICY NUMBER POLICY EFF MM/DD POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY TRA5122432 7/1/2017 7/1/2018 EACH OCCURRENCE $1,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $500,000 MED EXP (Any one person) $5,000 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY X� PRO- ❑ LOC JECT PRODUCTS-COMP/OPAGG $2,000,000 $ OTHER. A AUTOMOBILE LIABILITY TRA5122432 7/1/2017 7/1/2018 COMBINED Ea accident)SINGLELI $1,000,000 BODILY INJURY (Per person) $ X ANY AUTO ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ X HIRED AUTOAUTOS S X NON -OWNED AUTOS PROPERTY DAMAGE Per accident $ $ A X UMBRELLA LIAB X OCCUR TRA5122432 7/1/2017 7/1/2018 EACH OCCURRENCE $5,000,000 AGGREGATE $5,000,000 EXCESS LIAB CLAIMS -MADE DIED I X I RETENTION$0 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED" N (Mandatory in NH) N /A 4058803 7/1/2017 7/1/2018 X PER EIR STATUTE ER E.L. EACH ACCIDENT $500,000 E.L. DISEASE - EA EMPLOYEE $500,000 E.L. DISEASE - POLICY LIMIT $500,000 If yes, describe under DESCRIPTION OF OPERATIONS below A Installation Floater TRA5122432 7/1/2017 7/1/2018 Jobsite $1,000,000 Cause of Loss Form. Special Deductible. $1,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate Holder and those listed below(if any) are Additional Insureds as respects General Liability and Umbrella Liability on a Primary and Non -Contributory basis, and Auto Liability only if required by written contract or agreement and coverage applies only as respects work performed by the Insured for the Additional Insureds. All coverage terms, conditions, and exclusions of the policy apply. The Worker's Compensation, General Liability, Auto Liability, and Umbrella Liability policies include a Waiver of Subrogation in favor of the Additional Insureds only if required by written contract or agreement. Contractor's License. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Fort Collins THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN P.,O. Box 580 ACCORDANCE WITH THE POLICY PROVISIONS. Fort Collins CO 80522-0580 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD ACOR�0 CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 6/28/2017 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(les) 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 Olson & Olson Ltd 5655 S. Yosemite St. #200 Greenwood Village CO 80111 CONTACT NAME: P"oNE Ext). 303-867-2061 FAx . 303-867-2074 E-MAIL o2@olsonandolson,.com INSURERS AFFORDING COVERAGE NAIC;r INSURER A :Westfield Insurance Company 24112 _ INSURED MPBCO-1 INSURER B :Pinnacol Assurance 41190 MPB Contractors, Inc. 3155 Chambers Road INSURER C Aurora CO 80011 INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 729556736 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 VVITH 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. LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/LICY DD/YYYF MM/DD/YYYP LIMITS A X COMMERCIAL GENERAL LIABILITY TRA5122432 7/1/2017 7/1/2018 EACH OCCURRENCE $1,000,000 r� CLAIMS -MADE I � OCCUR l DAMAGE TO RENTED PREMISES Ea occurrence $500,000 IVIED EXP (Any one person) $5,000 PERSONAL & ADV INJURY $1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY a JE� LOC PRODUCTS - COMP/OP AGG $2,000,000 $ OTHER A AUTOMOBILE LIABILITY TRA5122432 7/1/2017 7/1/2018 MBINED IN LELIMI Ea accident $ 1,000,000 X BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY Per accident ( ) $ HIRED AUTOS X NON -OWNED AUTOS X PROPERTY DAMAGE Per accident $ A X UMBRELLA LIAB X OCCUR TRA5122432 7/1/2017 7/1/2018 EACH OCCURRENCE $5,000,000 AGGREGATE $5,000,000 EXCESS LIAB CLAIMS -MADE DED X RETENTION $0 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑N N/A 4058803 7/1/2017 7/1/2018 X PER 'ER' STATUTE ER E.L. EACH ACCIDENT $500,000 E.L. DISEASE - EA EMPLOYE $500,000 (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1 $500.000 A Installation Floater TRA5122432 7/1/2017 7/1/2018 Jobsite $1,000,000 Cause of Loss Form: Special Deductible. $1,000 I DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate Holder and those listed below(if any) are Additional Insureds as respects General Liability and Umbrella Liability on a Primary and Non -Contributory basis, and Auto Liability only if required by written contract or agreement and coverage applies only as respects work performed by the Insured for the Additional Insureds. All coverage terms, conditions, and exclusions of the policy apply. The Worker's Compensation, General Liability, Auto Liability, and Umbrella Liability policies include a Waiver of Subrogation in favor of the Additional Insureds only if required by written contract or agreement. Contractor's License. GEH I It-IGA I E HULUEH CANCELLATION City of Fort Collins P.,O. 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 © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD AC �® DATE (MM/DDNYYY) �,. CERTIFICATE OF LIABILITY INSURANCE 6/28/2017 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 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 PRODUCER Olson & Olson Ltd 5655 S. Yosemite St. #200 Greenwood Village CO 80111 INSURED MPBCO-1 MPB Contractors, Inc. 3155 Chambers Road Aurora CO 80011 NAME: PHONE FAX C No 303-867-2061 �� No). 303-867-2074 EAI -ML o2@olsonandolson.com INSURERS AFFORDING COVERAGE NAIC INSURER A :Westfield Insurance Company 24112 INSURERB:Pinnacol Assurance 41190 I INSURERC: INSURER D nnVFRAnPQ CFRTICICATG k11111A1zR0• 779.ri5Fi73Fi Dr1/iClnkl K111"01=0. 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 INSUR4NCE 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 TYPE OF INSURANCE INSD RF WVD POLICY NUMBER POLICY MM/DD/YYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS-MADEEx OCCUR TRA5122432 7/1/2017 7/1/2018 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $500,000 MED EXP (Any one person) $5,000 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY " PRO- n LOC PRODUCTS - COMP/OP AGG $2,000,000 $ OTHER A AUTOMOBILE LIABILITY TRA5122432 7/1/2017 7/1/2018 IN COMEaaecdent IN L L I $1,000,000 X BODILY INJURY (Per person) $ ANY AUTO ALL OWNEDSCHEDULED BODILY INJURY (Per accident) $ HIRED AUTOS X NON -OWNED AUTOS X PROPERTY DAMAGE Per accident $ $ A X UMBRELLA LIAB X OCCUR TRA5122432 7/1/2017 7/1/2018 EACH OCCURRENCE $5,000,000 AGGREGATE $5,000,000 EXCESS LIAB CLAIMS -MADE DED I X I RETENTION $0 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N 4058803 7/1/2017 7/1/2018 PER OTH- X STATUTE ER E.L. EACH ACCIDENT $500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? a N/A E.L. DISEASE - EA EMPLOYEE $500,000 (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $500,000 A Installation Floater TRA5122432 7/1/2017 7/1/2018 Jobsite $1,000,000 Cause of Loss Form: Special Deductible: $1,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate Holder and those listed below(if any) are Additional Insureds as respects General Liability and Umbrella Liability on a Primary and Non -Contributory basis, and Auto Liability only if required by written contract or agreement and coverage applies only as respects work performed by the Insured for the Additional Insureds. All coverage terms, conditions, and exclusions of the policy apply. The Worker's Compensation, General Liability, Auto Liability, and Umbrella Liability policies include a Waiver of Subrogation in favor of the Additional Insureds only if required by written contract or agreement. Contractor's License. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Fort Collins THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN P.,O. Box 580 ll ACCORDANCE WITH THE POLICY PROVISIONS. Fort Collins CO 80522.0580 AUTHORIZED REPRESENTATIVE © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD