HomeMy WebLinkAboutANTLER CONSTRUCTION CO - INSURANCE CERTIFICATE (10)ANTLE-6 OP ID: KR
ACORi7 DATE (MM/DD/YYYY)
�.,..,r CERTIFICATE OF LIABILITY INSURANCE F08/01/2017
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
certificate holder in lieu of such endorsement(s).
CONTACT
PRODUCER
Phone:303-202-0082 NAME:
Western Group Inc -Denver Fax: 303-202-0086 PHONE -- — F
6425 West 44th Ave (A/C No Ect): IAIC, No):
PO Box 497 E-MAIL
Wheatridge, CO 80034 ADDRESS: _
Jim Howes INSURERS AFFORDING COVERAGE NAIC #
INSURER A: United Specialty Insurance Co. 12537
INSURED Antler Construction, CO. INSURER B : Auto -Owners Insurance Co 18988
546 SE 8th Street,Unit B4
Loveland, CO 80537 INSURER c
INSURER D :
INSURER E :
INSURER F :
('[]VFRAt7,FS CFRTIFICATE Nt1MRER- 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
OF INSURANCE
ADDLTYPE
INSR
SUER
POLICY NUMBER
EFF
MMI DY/YYYY
POLICY XP
MMIDD/Y
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE OCCUR
ATN-ATL1760556
08/01/2017
08/01/2018
EACH OCCURRENCE
$ 1,000,000
DAMAGE TO RENTED
PREMISES Ea occurrence
$ 100,000
MED EXP (Any one person)
$ 5,000
PERSONAL & ADV INJURY
$ 1,000,00
GENERAL AGGREGATE
$ 2,000,000
GE N L AGGREGATE LIMIT APPLIES PER:
I POLICY 17 PRO- � LOC
PRODUCTS - COMP/OP AGG
$ 2,000,00
$ -�
B
AUTOMOBILE LIABILITY
_
ANY AUTO
r X ALL OWNED SCHEDULED
AUTOS AUTOS
X HIRED AUTOS X NON -OWNED
AUTOS
I4888439100
106/28/2017
06/28/2018
COMBINED SINGLE LIMIT
Ea accient d
BODILY INJURY (Per person)
1,000,000�
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
Per accident
_
$
UMBRELLA LIAB
EXCESS LIAR
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
$
AGGREGATE
$
DED RETENTION $
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY N
YIN
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? ❑
{Man2.a?crY in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
N / A
STATU- OTH -
T RY LIMIT R
TWO
$
E.L. EACH ACCIDENT
E.L._DISEASE - EA_E_MPLOYEE
_
$
E.L. DISEASE - POLICY LIMIT
—
$
I
j
i
I
I
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
I
f1C0TICIf`AT0 Uni MUD CANCFI I ATInN
CITYFTC
I
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
City of Fort Collins
330 S. College Ave.
P.O. BOX S8O
AUTHORIZED REPRESENTATIVE
Jim Howes
Fort Collins, CO 80522-0580
V 1Ut$t5-ZU1U ACUKLI L;UKt'UKAI IUN. All ngnis reserve0.
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD