HomeMy WebLinkAboutBLUSKY RESTORATION CONTRACTORS INC - INSURANCE CERTIFICATE (2)oRo® CERTIFICATE OF LIABILITY INSURANCE 75/31/2018
(MM/DDYIYY)
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: Jade Spaeth
Arthur J. Gallagher Risk Management Services, Inc. PHONE FAX
6300 South Syracuse Way, Suite 700 , No Ext 303-889-2558 A/c No):
Centennial CO 80111 ADDRESS jade_spaeth@aig_.com
INSURER(S) AFFORDING COVERAGE
NAIC 8
INSURER A: Tokio Marine Specialty Ins Co
23850
INSURED
BluSky Restoration Contractors, LLC
9767 E. Easter Ave.
Centennial CO 80112
INSURER B: Liberty Mutual Fire Insurance Company
23035
INSURER C: Philadelphia IndemnityInsurance Company
18058
-
INSURER D:
INSURER E :
INSURER F :
COVFRAGFS CFRTIFICATF NUMBFR:912942705 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 ADDL SUER POLICY EFF T POLICY EXP LIMITS
T TYPE OF INSURANCE POLICY NUMBER M/ D/YYY MM/DDf (Y
A
X
COMMERCIAL GENERAL LIABILITY
PPK1828149
8/1/2018
5/1/2019
EACH OCCURRENCE
$ 1.000,000
CLAIMS -MADE a OCCUR
DAMAGE TO RENTED__
PREMISES Ea occurrence
$10(),000
MED EXP (Any one person)
$ 5,000
PERSONAL & ADV INJURY
$ 1,000,000
GEN'L
AGGREGATE LIMIT APPLIES PER:
GENERALAGGREGATE
$2,000,000
POLICY a PRO- LOC
PRODUCTS -COMP/OP AGG
$ 2,000,000
S
OTHER:
C
AUTOMOBILE LIABILITY
PHPK1827622
&1/2018
5/1/2019
COMBINED SINGLE LIMIT
Ea accident
$ 1'000'000
BODILY INJURY (Per person)
$
X ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
BODILY INJURY (Per accident)
S
PROPERTY DAMAGE
Per acciden
$
NON -OWNED
X HIRED Ix
AUTOS ONLY AUTOS ONLY
ComplCol Deductible
_ .....
$ 1,000
A
X
UMBRELLA LIAR
X
OCCUR
PUB631346
&1/2D18
511/2019
EACH OCCURRENCE
$10,000,000
X
AGGREGATE
S 10,000,000
EXCESS LIAB
CLAIMS -MADE
DED RETENTIONS
$
g
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y/ N
WC2-Z91-462479-018
5/1/2018
511/2019
X STATUTE ER
ANYPROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
N / A
E.L. EACH ACCIDENT
$ 1,000,000
(Mandatory in NH)
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)
BluSky Restoration Contractors, Inc. certifies that liability insurance in the amount of $1,000,000 that indemnifies the City against any and all loses that may
arise from the use of the parking spaces per contract stipulations.
CERTIFICATE HOLDER CANCELLATION
City of Ft. Collins
215 N. Mason Street
Ft. Collins CO 80537
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
0 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD