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HomeMy WebLinkAboutUNITED SUBCONTRACTORS INC DBA POWERS INSULATION - INSURANCE CERTIFICATE.�1 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/VYYY) I 06/11/201$ 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: (A/CO.NNo. Ext): (866) 283-7122 ac No.): (800) 363 0105 E-MAIL ADDRESS: 3000 Town Center Suite 3000 INSURER(S) AFFORDING COVERAGE NAIC # Southfield MI 48075 USA INSURED INSURER A: Lloyds Syndicate No. 1969 AA1120106 United Subcontractors. Inc. INSURER B: ACE American Insurance Company 22667 d/b/a Powers Insulation 2645 Durango Drive INSURER C: old Republic Insurance Company 24147 INSURER D: Colorado Springs CO 80910 USA INSURER E: iNSUER F: COVERAGES CERTIFICATE NUMBER: 570071628652 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 ILTR TYPE OF INSURANCE NSD WVD POLICY NUMBER MM/DD NYYY MM/DD/YYYY LIMITS C X COMMERCIAL GENERAL LIABILITY Y Y MWZY 1 1 1 EACH OCCURRENCE $2,000,000 CLAIMS -MADE X❑ OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $2,000,000 MED EXP (Any one person) $25 , 000 PERSONAL &ADV INJURY $2,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $4 , 000 , 000 POLICY PRO ❑ LOC PRODUCTS - COMP/OP AGG $4,000,000 JECT OTHER: C AUTOMOBILE LIABILITY Y MWTB 313070 06/30/2018 06/30/2019 COMBINED SINGLE LIMIT Ea accident $S,000,OOO BODILY INJURY ( Per person) X ANYAUTO BODILY INJURY (Per accident) OWNED SCHEDULED AUTOS ONLY AUTOS PROPERTY DAMAGE HIREDAUTOS NON -OWNED Per accident ONLY AUTOS ONLY A X UMBRELLA LIAB OCCUR Y CSUSA1801330 06/30/2018 06/30/2019 EACH OCCURRENCE $5,000,000 EXCESS LIAB H CLAIMS -MADE AGGREGATE $5,000,000 DED RETENTION B WORKERS COMPENSATION AND WLRC4858147A 06/30/2018 06/30/2019 X STATUTE EORH EMPLOYERS' LIABILITY YIN All Other States E. L. EACH ACCIDENT $1,000,000 B ANYPROPRIETOR/PARTNER /EXECUTIVE NIA SCFC48581481 06/30/2018 06/30/2019 OFFICER/MEMBEREXCLUDE D? (Mandatory in NH) wI only E.L. DISEASE -EA EMPLOYEE $1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $1,000,000 B Excess WC wcuc48581493 06/30/2018 06/30/2019 EL Each Accident $1,000,000 WA Stop Gap Only EL Disease - Policy $1,000,000 SIR applies per policy ter s & condi ions EL Disease - Ea Emp $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) [Pro]: Re: Ft. Collins Senior Center, 7534 Raintree Drive, Ft. Collins, Colorado.] [AI: City of Ft. Collins and Ft. Collins Senior Center] are included as an Additional Insured with respect to the General Liability, Automobile Liability and Excess policies, as required by written contract. A waiver of Subrogation is provided for the above referenced General Liability policy, as per 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 Ft. Collins AUTHORIZED REPRESENTATIVE 215 N. Mason St. Ft. Collins CO 80522 USA N LO tD cc 0 0 r` LO O Z 0) W U If 07 U Z I— r'a ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD