HomeMy WebLinkAboutBUILDINGS BY DESIGN - INSURANCE CERTIFICATEte- C> �® 72/7/2018
(MM/DD/YYYY)
ACCERTIFICATE OF LIABILITY INSURANCE
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: Scott Anderson, CIC
Commercial Risk Solutions PHONE FAX
6600 E Hampden Ave Ste 200 A/c N x : 303-996-7833 A/c No : 303-757-7719
Denver CO ADDRESS: sandersonAcmdenver.com
_
INSURED BUILD-6
Buildings By Design, LLC.
18163 County Road 26
Brush CO 80723
INSURER A: Westfield Insurance
INSURER B: Pinnacol Assurance
INSURERC:
INSURER D :
INSURER E :
cnVFRAGFS (-FRTIFIr'ATF NI IMRFR• R57?776A1 RFVISI17)N NI IMRFR•
24112
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
LTR
TYPE OF INSURANCE
ADDL
SUBR
POLICY NUMBER
POLICY EFF
MM/DD/YYY
POLICY EXP
MM/DD/YYY
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
Y
TRA3658080
2/10/2018
2/10/2019
EACH OCCURRENCE
$1,000,000
CLAIMS -MADE T 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:
POLICY PET LOC
GENERAL AGGREGATE
$2,000,000
PRODUCTS - COMP/OP AGG
S 2,000,000
$
OTHER:
A
AUTOMOBILE
LIABILITY
Y
TRA3658DSO
2/10/2018
2/10/2019
CO M..,.n,SINGLE LIMIT
$ 1.000.000
BODILY INJURY (Per person)
$
X
ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
BODILY INJURY (Per accident)
$
HIRED X NON -OWNED
AUTOS ONLY AUTOS ONLY
X
PROPERTY DAMAGE
Per acciden
$
Broadened Pollution
$ Included
A
X
UMBRELLA LIAB
X
OCCUR
TRA365WBO
2/102018
2/1012019
EACH OCCURRENCE
$5,000,000
AGGREGATE
$ 5,000,000
EXCESS LIAB
CLAIMS -MADE
DED I X RETENTION b
$
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
4073732
10/1/2017
10/12018
X PER OTH-
STATUTE ER
E.L. EACH ACCIDENT
$500,000
ANYPROPRIETOR/PARTNER/EXECU I IVE ❑
OFFICER/MEMBER EXCLUDED? Y
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
Inland Marine
TRA3658080
2/102018
2/102019
Rent/Leased
50,000
Equipment/ACV/Special
i
Deductible
500
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
The City of Fort Collins, its officers, agents and employees included as additional insured for ongoing operations on the General Liability and included as
additional insured on the Auto Liability with respect to operations of the named insured for the certificate holder as required by written contract. All policy terms,
conditions and exclusions apply.
CERTIFICATE HOLDER CANCELLATION
City of Fort Collins Financial Services Purchasing Division
215 N Mason Street 2nd Floor
Ft. Collins CO 80522
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
G 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD