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HomeMy WebLinkAbout565996 BLACK EAGLE FENCE INC - INSURANCE CERTIFICATE (3)BLACK06 OP ID: BS AFRO CERTIFICATE OF LIABILITY INSURANCE DA05/30/2018TE Y) 05/3012018 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). PRODUCER Phone: 970-223-1804 CONTACT NAME: Front Range Insurance Group 2002 Caribou Drive, Ste. 101 Fax: Fort Collins, CO 80525 AssuredPartners Colorado PHONEFAx A/c. No. ExtJ: A/c No]: E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC M INSURER A : Acuity _ INSURED Black Eagle Fence, Inc. INSURER B : Pinnacol Assurance 41190 Randy Peck PO Box 295 INSURER C : INSURER D : Loveland, CO 80539 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 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. I�TR TYPE OF INSURANCE I POLICYPOLICY NUMBER MM DD/YEYYY) (MMODD/YYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY IVI CLAIMS -MADE OCCUR X Z67437 06/01/2018 06/01/2019 EACH OCCURRENCE $ 1,000,00 DAMAGE TO R ENTED PREMISES Ea occurrence $ 100,00 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: 17 POLICY X PRO LOC PRODUCTS - COMP/OP AGG $ 2,000,00 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS X NON -OWNED AUTOS X Z67437 06/01/2018 06/01/2019 COMBINED SINGLE LIMIT Ea accident $ 1,000,00 BODILYINJURY(Perperson) $ JX BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE Z67437 06/01/2018 06/01/2019 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 $ DED I X I RETENTION $ $10000 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/ N OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N I A 4148836 06/01/2018 06/01/2019 X I WC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEO $ 1,000,000 E.L. DISEASE - POLICY LIMIT 1 - $ 1,000,000 A Equipment Floater Z67437 06/01/2018 06/01/2019 Lsd & Ren 50,000 Inst Fit 75,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Certificate holder is additional insured with respec to General Liability and Automobile. CERTIFICATE HOLDER CANCELLATION CITYOFF City of Fort Collins Director of Purchasing & Risk Management PO Box 580 Fort 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 '::�6 © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD