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HomeMy WebLinkAboutUNITED SUBCONTRACTORS INC DBA POWERS INSULATION - INSURANCE CERTIFICATE (2)Page 1 of 1 A�RD© CERTIFICATE OF LIABILITY INSURANCE DATE 21/2017 o6,21/2017 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 CONTACT NAME: PHOWC.NE FAX 1-877-945-7378 1-888-467-2378 o Ext: A/C No: Willis of Minnesota, Inc. c/o 26 Century Blvd P.O. Box 305191 E-MAIL ADDRESS: certificates@willis.com INSURERS AFFORDING COVERAGE NAIC# Nashville, TN 372305191 USA INSURER A: Crum & Forster Specialty Insurance Company 44520 INSURED United Subcontractors, Inc. #208 dba Powers Insulation INSURER B: Starr Indemnity & Liability Company 38318 INSURER C: First Specialty Insurance Corporation 34916 INSURER D: 2645 Durango Dr. INSURER E Colorado Springs, CO 80910 USA INSURER F : COVERAGES CERTIFICATE NUMBER: W2686126 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 ADDL SUBR POLICY NUMBER FOLICY EFF YYYY FOLIC EXP LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 5,000,000 CLAIMS -MADE FxI OCCUR PREMISES Ea occurrence) $ 500,000 MED EXP (Any one person) $ 10,000 A Y Y ECG-103268 07/01/2017 07/01/2018 PERSONAL & ADV INJURY $ 51000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 5,000,000 PRODUCTS - COMP/OPAGG $ 5,000,000 POLICY X jECT a LOC $ OTHER: AUTOMOBILE LIABILITY COMBINEDSINGLELIMIT Ea accident $ 2,000,000 BODILY INJURY (Per person) $ X ANY AUTO BODILY INJURY (Per accident) $ B OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY Y N 1000198523171 07/01/2017 07/01/2018 PROPERTY DAMAGE Per accident $ $ C UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE Y N IRE2000978 00 07/01/2017 07/01/2018 EACH OCCURRENCE $ 5,000,000 X AGGREGATE $ 5,000,000 DED RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N OFFICEANYPROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBEREXCLUDED? No (Mandatory in NH) N/A N 100 0002277 07/01/2017 07/01/2018 X OTH STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE 1,000,000 $ E.L. DISEASE - POLICY LIMIT $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Project: Ft. Collins Senior Center, 7534 Raintree Drive, Ft. Collins, Colorado. Certificate Holder and Ft. Collins Senior Center are included as additional insured (except Workers' Compensation) where required by written contract. Waiver of subrogation is applicable where required by written contract. rFRTIFIrATF Hint nFR CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE _ THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN .ACCORDANCE WITH -THE POLICY PROVISIONS.'_ . .. `..—_-s•:�-- ='�—'- AUTHORIZED, REPRESENTATIVE City Of Ft. Collins 215 N. Mason St. Ft. Collins, CO 80522 U ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD SR ID: 14741210 BATCH: 358447