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HomeMy WebLinkAboutBUILDER SERVICES GROUP INC DBA MATO - INSURANCE CERTIFICATE (10)'�1 ® ,4 o CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 06/12/2017 I 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 Aon Risk Services Central, Inc. Southfield MI office CONTACT NAME: (AICO.NN. Ext): (866) 283-7122 (A/C. No.): (800) 363-0105 E-MAIL ADDRESS: 3000 Town Center Suite 3000 Southfield MI 48075 USA INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A: ACE American Insurance Company 22667 Builder Services Group, Inc. INSURER B: Old Republic insurance Company 24147 d/b/a Allied Insulation A TopBuild Company INSURER C: Lloyd's Syndicate No. 1969 AA1120106 INSURER D: 6617 S. College Ave. Fort Collins Co 80525 USA INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570066885581 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. Limits shown are as requested INSR LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM DD/YYYY MMIDD/YYYY LIMITS B X COMMERCIAL GENERAL LIABILITY MWZY 106/30/2018 EACH OCCURRENCE $2,000,000 CLAIMS -MADE X❑ OCCUR DAMAGE RENTED $2,000,000 PREMISES Ea occurrence MED EXP (Any one person) $2 5 , 000 PERSONAL &ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $4 , 000 , 000 X POLICY ❑ PRO ❑ LOC JECT PRODUCTS - COMPIOP AGG $4,000,000 OTHER. B AUTOMOBILE LIABILITY MWTB 310454 06/30/2017 06/30/2018 COMBINED SINGLE LIMIT Ea accident $5 , 000 , 000 BODILY INJURY ( Per person) X ANY AUTO BODILY INJURY (Per accident) OWNED SCHEDULED AUTOS ONLY AUTOS PROPERTY DAMAGE HIRED AUTOS NON -OWNED Per accident ONLY AUTOS ONLY C X UMBRELLA LIAB X OCCUR CSUSA1701330 06/30/2017 06/30/2018 EACH OCCURRENCE $2,000,000 EXCESS LIAB CLAIMS -MADE AGGREGATE $2,000,000 DED RETENTION A WORKERS COMPENSATION AND WLRC48032461 06/30/2017 06/30/2018 X PER OTH- STATUTE R EMPLOYERS' LIABILITY YIN All other States E.L. EACH ACCIDENT $1, 000, 000 A' ANY PROPRIETOR/ PARTNER I EXECUTIVE NIA SCFC48032473 06/30/2017 06/30/2018 OFFICEJMEMBEREXCLUDED (Mandatory in NH) WI Only E.L. DISEASE -EA EMPLOYEE $1 , 000 , 000 If yes, describe under DESCRIPTION OF OPERATIONS Selo. F L DISEASE -POLICY I IMIT $1_ , 000 , 000 A Excess WC WCUC47863533 01/01/2017 06/30/2017 EL Each Accident $1,000,000 WA only EL Disease - Policy $1,000,000 SIR applies per policy terms & condi ions EL Disease - Ea Emp' $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) [Prof: RE: Project Name: City of Fort Collins - Home Efficiency Program.] [AI: City of Fort Collins] is included as an Additional Insured with respect to the General Liability policy, as required by written contract. CERTIFICATE HOLDER 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. City Of Fort Collins AUTHORIZED REPRESENTATIVE Attn: Amber Riley 700 wood st Fort Collins Co 80521-1945 USA u') W 0 O rr) Ln O Z d 15 U w d U ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD